Understanding your asthma severity has implications for your asthma control. Severity is linked to the asthma treatment and monitoring your healthcare provider will recommend.

Without measuring your asthma regularly, you will have difficulty knowing if interventions are improving your asthma or if your asthma is worsening. As a result, asthma may be limiting your day-to-day activities and you might not even realize it.

By reviewing the table below, you can classify your asthma severity based on the National Heart, Lung, and Blood Institute’s (NHLBI) guidelines as either:

  • Intermittent
  • Mild persistent
  • Moderate persistent
  • Severe persistent

Your asthma severity is based on the criteria described below. You classify yourself based on your worst symptom. For example, if you are waking up two nights per month with a cough or feeling short of breath, your asthma is in the intermittent asthma severity classification.

If you have symptoms two days per week, use your rescue inhaler two times per week, have a normal FEV1 between exacerbations, but wake up at night three times per week, your asthma severity is moderate persistent. Your asthma treatment will, in part, be based on your asthma severity.

Asthma Severity

Severity is based on symptoms associated with poor asthma control. The table uses the following criteria to determine asthma severity:

Progressive, moderate to severe, persistent, or recurrent symptoms can be a sign of a serious medical condition. Anyone with symptoms such as these should seek medical attention immediately.  

  • Symptoms: How many days in the past week have you experienced chest tightness, cough, shortness of breath, or wheezing?
  • Nighttime awakenings: How often do you wake up at night with chest tightness, cough, shortness of breath, or wheezing?
  • Rescue inhaler use: How many times in the last week have you used your rescue inhaler?
  • FEV1: What is your current lung function measured with spirometry? Unlike the other above symptoms, your FEV1 will not be readily available at home; you will need to ask your healthcare provider when pulmonary function tests are performed.

A Word From Verywell

There is some debate among experts today whether asthma action plans based off of symptoms are more effective than plans based off of peak flow or even home FEV1. You can talk with your healthcare provider and determine which one they recommend and which one might be best for you.

  • Clinical Pulmonary Function Testing, Exercise Testing, and Disability Evaluation. In Chest Medicine: Essentials Of Pulmonary And Critical Care Medicine. Editors: Ronald B. George, Richard W. Light, Richard A. Matthay, Michael A. Matthay. 5th Edition.
  • National Heart, Lung, and Blood Institute. May 20, 2010. Expert Panel Report 3 (EPR3): Guidelines for the Diagnosis and Management of Asthma.

By Pat Bass, MD

Dr. Bass is a board-certified internist, pediatrician, and a Fellow of the American Academy of Pediatrics and the American College of Physicians.