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How Does Classification Help? Asthma is a long term disease, and treatment is necessarily long term, often with drugs that have important side effects. This classification of asthma helps us to select the treatment level most appropriate for the child. Remember, undertreatment is also dangerous -- it can lead to permanent changes in the lungs that cannot be treated later. This classification helps us to choose initial treatment. The treatment should later be guided by achievement of the asthma treatment goals.

Classification of Asthma

The treatment of asthma has been greatly simplified and standardized by the 1997 document "Guidelines for the diagnosis and management of asthma", published by the National Institutes of Health, USA. An important component is the classification system, which puts all people with asthma into one of four severity categories. This allows the child to receive appropriate therapy -- enough to benefit him, but not overtreatment.

Mild intermittent asthma

These children have infrequent symptoms like cough and wheeze -- less than twice in one week. The episodes of asthma are short lived, and the child is well between episodes. Lung function, if tested, is close to normal, and the child sleeps well, with night time symptoms not occurring more than twice in a month.
These children should be given reliever medicine as required. Inhaled salbutamol or terbutaline is best. Their airway inflammation is mild, and continuous treatment is not required. As with all types of asthma, regular assessment by a specialist is essential.

Mild persistent asthma

These children have symptoms of asthma - cough, wheeze, and breathlessness -- more than twice a week, but not daily. The acute episodes they have are likely to affect activity. They also have night time problems more than twice in one month.
Though their lung function tests give near normal results, these children have reached a level of airway inflammation that requires ongoing treatment to control the disease and preserve lung function.

Moderate persistent asthma

These children have symptoms requiring reliever medication daily, and have night time symptoms at least once a week. Their activity is restricted, they have frequent school absences, and lung function tests are significantly abnormal.

These children have significant airway inflammation, and need inhaled steroids on a regular basis to keep their disease under control. Untreated, they have frequent exacerbations, and their lung function goes on deteriorating. Even when relatively well, controller therapy must be continued.

Severe persistent asthma

Symptoms of asthma are almost continuous, and these children have severely restricted activity, frequent school absences and hospital admissions, and find it difficult to sleep through the night. The lung function test reports are grossly abnormal, and these children are unable to indulge in much physical activity.
These children need vigorous therapy, including high dose inhaled steroids. Other possible measures are long acting beta agonists, slow release formulations of theophylline, and leukotrienne modifiers.

All children with asthma must follow allergen avoidance measures. These will vary from child to child, depending on known triggers.

A child's asthma can improve or worsen with time, and frequent follow up with a specialist is necessary to step up or step down the treatment. A general principle is to start with a higher grade of treatment, and step down as the asthma comes under control.

Last revision: July 15, 2007

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