Asthma is a common, long-term condition that affects a person's airways. The Centers for Disease Control and Prevention (CDC) estimate that 8.1 percent of adults and 8.4 percent of children in the United States have asthma.
This article explores the symptoms and treatments at each asthma stage.
What are the stages of asthma?
Breathing difficulties are a common symptom of asthma.
Asthma can be either intermittent or persistent. When symptoms arise occasionally, a person has intermittent asthma. Symptoms of persistent asthma occur more often.
The four main asthma stages are:
- mild persistent
- moderate persistent
- severe persistent
These classifications are for people with asthma who do not take long-term controller medication.
The symptoms of asthma are the same at every stage, but their frequency and severity differ.
The main symptoms of asthma include:
- tightening of the chest
- breathing difficulties
We explore each asthma stage in detail below.
1. Intermittent asthma
This is the least severe type. Doctors sometimes call it mild intermittent asthma.
For a person with intermittent asthma:
- symptom frequency: Symptoms may occur about 2 days a week or less often.
- nighttime awakenings: Symptoms may wake a person two or fewer times each month.
- severity: Symptoms will not interfere with regular activities.
- lung capacity: The result of a forced expiratory volume (FEV) lung capacity test is usually 80 percent or more of normal values.
- inhaler use: A person will need to use a short-acting beta agonist (SABA) inhaler to control symptoms on 2 or fewer days each week.
2. Mild persistent asthma
This is the least severe form of persistent asthma.
For a person with mild persistent asthma:
- symptom frequency: Symptoms will occur more often than twice a week but not every day.
- nighttime awakenings: Symptoms tend to wake a person three or four times a month.
- severity: Symptoms may have a minor impact on regular activities.
- lung capacity: The result of a FEV lung capacity test is often 80 percent or more of normal values.
- inhaler use: A person will need to use a SABA inhaler to control symptoms more often than twice a week but not daily.
3. Moderate persistent asthma
This is the second most severe form of asthma.
For a person with moderate persistent asthma:
- symptom frequency: Symptoms will occur on a daily basis.
- nighttime awakenings: Symptoms will wake a person more often than once a week but not every night.
- severity: Symptoms will limit regular activities somewhat.
- lung capacity: The result of a FEV lung capacity test tends to be 60–80 percent of normal values.
- inhaler use: A person will need to use a SABA inhaler on a daily basis.
4. Severe persistent asthma
A person will need to use an inhaler several times a day if they have severe persistent asthma.
Severe persistent asthma is the most serious form. For a person with this type of asthma:
- symptom frequency: Symptoms will arise throughout the day.
- nighttime awakenings: A person will likely be woken by symptoms every night.
- severity: Symptoms will significantly limit regular activities.
- lung capacity: The result of a forced vital capacity lung function test tends to be less than 60 percent of normal values.
- inhaler use: A person will need to use a SABA inhaler to control symptoms several times a day.
Treatment at each asthma stage
The U.S. National Asthma Education and Prevention Program recommend a stepwise treatment plan for asthma. This involves stepping up treatments, depending on how severe a person's asthma is.
According to guidance published in American Family Physician, inhaled corticosteroids (ICSs) are the most effective single therapy for asthma.
If this medication is not completely effective, a doctor may add other agents to the corticosteroids.
Each treatment step aligns with a different asthma type. For the most severe types of asthma, there are several treatment steps.
Intermittent asthma: Step 1
Intermittent asthma treatment focuses on using a SABA inhaler to relieve symptoms whenever needed.
The doctor does not usually prescribe a controller medication at this stage.
Mild persistent asthma: Step 2
People can treat mild asthma that persists over long periods with long-term control medications. These can reduce symptoms when used on a daily basis.
Doctors prefer to prescribe a low-dose ICS as a controller medication for mild persistent asthma.
In addition, a person can use a SABA inhaler when needed to relieve symptoms.
Moderate persistent asthma: Step 3
Doctors also use long-term daily medication to treat moderate asthma that persists over long periods. These medications are often different from those that treat milder forms of asthma.
For moderate persistent asthma, doctors prefer to use either:
- a combination of a low-dose ICS and a long-acting beta agonist (LABA)
- a medium-dose ICS
Alternative therapies include a low-dose ICS along with an LTRA or, less commonly, theophylline.
In addition, a person can use a SABA inhaler when needed to relieve symptoms.
Moderate to severe persistent asthma: Step 4
People with moderate to severe persistent asthma will need to use several medications.
As symptoms of moderate persistent asthma become more severe, the preferred controller medications change.
Options for controller medications for moderate to severe persistent asthma include:
- a medium-dose ICS plus a LABA, which is the preferred method
- a medium-dose ICS plus an LTRA
- a medium-dose ICS plus theophylline, which is a less common, less effective choice
People can also use a SABA inhaler when needed to relieve symptoms.
Severe persistent asthma: Step 5
If step 4 medications do not reduce the symptoms of severe persistent asthma, the doctor may prefer to combine a high-dose ICS and a LABA.
They may also consider omalizumab (Xolair) for people with allergies.
Severe persistent asthma: Step 6
If symptoms of severe persistent asthma have not responded to the previous treatments, the doctor may prescribe a high-dose ICS alongside both a LABA and an oral corticosteroid.
They may also consider omalizumab for people with allergies.
Asthma is a long-term condition that affects the airways. People can often manage symptoms well with the right treatments.
Doctors classify four main stages of asthma, and each has its own treatment options. These change as symptoms increase in severity. A good doctor will work with a person to find a treatment plan that manages their symptoms effectively.
Long-term asthma management also involves avoiding triggers and reducing exposure to allergens. Stress management techniques and regular exercise to strengthen the lungs can also help.
Smoking is a major asthma trigger, and quitting will improve a person's symptoms. The doctor can provide support to anyone who wants to make this change.
Making lifestyle modifications and following a treatment plan are the best ways that a person with asthma can improve their quality of life.
What are the causes of mild asthma at night time?
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