Asthma Stages
According to the Mayo Clinic, asthma is a disease characterized by constricting airways, swelling and mucus production in response to environmental triggers. The National Institutes of Health classifies asthma based on four stages created to help health-care practitioners treat asthma. Regardless of stage, the mainstays of treatment include medications, environmental control, patient education and ongoing adjustments to treatment as needed.
Stage 1
The first stage of asthma is called "intermittent" because symptoms such as wheezing come and go. This stage is defined by symptoms occurring no more than two times per week and nighttime awakening occurring no more than twice per month. There is no interference with normal activity and normal lung function. Inhaler use is less than three days per week. Suggested initial treatment is with a short-acting inhaler such as albuterol as needed. Albuterol is a "beta agonist," a class of drugs that dilates the airways when inhaled.
- The first stage of asthma is called "intermittent" because symptoms such as wheezing come and go.
Stage 2
Differences Between Asthma and Bronchitis
Learn More
Stage 2 asthma is called "mild persistent." It is characterized by symptoms that occur greater than two days per week but not daily, and three to four nighttime awakenings each month. Inhaler use may be greater than two days per week, although not on a daily basis, and not more than one time per day. There may be minor limitation in normal activity. Treatment includes a short-acting beta agonist rescue inhaler as in the first stage and also adds a long-acting medication, usually inhaled steroids to suppress the overactive immune response in the lungs.
- Stage 2 asthma is called "mild persistent."
- Treatment includes a short-acting beta agonist rescue inhaler as in the first stage and also adds a long-acting medication, usually inhaled steroids to suppress the overactive immune response in the lungs.
Stage 3
Stage 3 asthma is called "moderate persistent." In this stage, the asthmatic will have daily symptoms of asthma, nighttime awakenings more than once per week, daily need of short-acting rescue medication, some limitation in normal activity and decreased lung function. Treatment at this stage is either a low-dose inhaled steroid and a long-acting beta agonist. Alternatively medium-dose inhaled steroids may be used in addition to a short-acting beta agonist such as albuterol.
- Stage 3 asthma is called "moderate persistent."
- In this stage, the asthmatic will have daily symptoms of asthma, nighttime awakenings more than once per week, daily need of short-acting rescue medication, some limitation in normal activity and decreased lung function.
Stage 4
Treatment for Asthmatic Bronchitis
Learn More
Stage 4 asthma is known as "severe persistent asthma." Symptoms occur throughout the day, and nighttime awakening may occur every night. The asthma attacks severely limit normal activity. A short-acting rescue drug may be required several times per day. Lung function is noticeably reduced. Treatment is high-dose inhaled steroids and a long-acting beta agonist. If that does not control the symptoms, oral steroids are added. Alternative drugs are available at all stages, as are allergy shots if the asthma is a result of general allergies.
- Stage 4 asthma is known as "severe persistent asthma."
- Alternative drugs are available at all stages, as are allergy shots if the asthma is a result of general allergies.
Related Articles
References
- National Institutes of Health: Guidelines for the Diagnosis and Management of Asthma: Summary Report 2007
- National Institutes of Health: Guidelines for the Diagnosis and Management of Asthma: Full Report 2007
- Mayo Clinic: Asthma
- Centers for Disease Control and Prevention. Consumer Information. Asthma.
- Expert Panel Report 3 (EPR3): Guidelines for the Diagnosis and Management of Asthma.
- Franks TJ, Burton DL, Simpson MD. Patient medication knowledge and adherence to asthma pharmacotherapy: a pilot study in rural Australia. Ther Clin Risk Manag. 2005;1(1):33–38. doi:10.2147/tcrm.1.1.33.53598
- Vernon MK, Wiklund I, Bell JA, Dale P, Chapman KR. What do we know about asthma triggers? A review of the literature. J Asthma. 2012;49(10):991-8. doi:10.3109/02770903.2012.738268
- Jiménez-ruiz CA, Andreas S, Lewis KE, et al. Statement on smoking cessation in COPD and other pulmonary diseases and in smokers with comorbidities who find it difficult to quit. Eur Respir J. 2015;46(1):61-79. doi:10.1183/09031936.00092614
- Mastronarde JG. Is There a Relationship Between GERD and Asthma? Gastroenterol Hepatol (N Y). 2012;8(6):401-3.
- Dogra S, Kuk JL, Baker J, Jamnik V. Exercise is associated with improved asthma control in adults. Eur Respir J. 2011;37(2):318-23. doi:10.1183/09031936.00182209
- Barnes PJ. Inhaled Corticosteroids. Pharmaceuticals (Basel). 2010;3(3):514-540. doi:10.3390/ph3030514
- Beasley R, Martinez FD, Hackshaw A, Rabe KF, Sterk PJ, Djukanovic R. Safety of long-acting beta-agonists: urgent need to clear the air remains. Eur Respir J. 2009;33(1):3-5. doi:10.1183/09031936.00163408
- Gadde D, Creticos P, Beakes D, et al. Adverse Effects Associated with Leukotriene Antagonist Therapy. Journal of Allergy and Clinical Immunology. 2010;125(2). doi:10.1016/j.jaci.2009.12.266
- Sorkness CA, Schend VA. Monitoring for Side Effects from Treatment. Clinical Asthma. 2008:313-319. doi:10.1016/b978-032304289-5.10035-9
- Ramsahai JM, Wark PA. Appropriate use of oral corticosteroids for severe asthma. Med J Aust. 2018;209(S2):S18-S21. doi:10.5694/mja18.00134
- U.S. National Library of Medicine. Asthmanefrin. 2017.
- NIH National Center for Complementary and Integrative Health. Asthma: In Depth. Updated September 24, 2017.
- Freitas DA, Holloway EA, Bruno SS, Chaves GS, Fregonezi GA, Mendonça KP. Breathing exercises for adults with asthma. Cochrane Database Syst Rev. 2013;(10):CD001277. doi:10.1002/14651858.CD001277.pub3
- Wechsler ME, Kelley JM, Boyd IO, et al. Active albuterol or placebo, sham acupuncture, or no intervention in asthma. N Engl J Med. 2011;365(2):119-26. doi:10.1056/NEJMoa1103319
- Medici TC, Grebski E, Wu J, Hinz G, Wüthrich B. Acupuncture and bronchial asthma: a long-term randomized study of the effects of real versus sham acupuncture compared to controls in patients with bronchial asthma. J Altern Complement Med. 2002;8(6):737-50. doi:10.1089/10755530260511748
- National Center for Complementary and Integrative Health. Asthma: In Depth.
- Wechsler ME, Kelley JM, Boyd IOE, et al. Active Albuterol or Placebo, Sham Acupuncture, or No Intervention in Asthma. New England Journal of Medicine. 2011;365(2):119–126. doi:10.1056/NEJMoa1103319
- Wilhelm CP, Chipps BE. Bronchial Thermoplasty: A Review of the Evidence. Ann Allergy Asthma Immunol. 2016;116:92-98. doi:10.1016/j.anai.2015.11.002
- Centers for Disease Control and Prevention. Consumer Information. Asthma.
- Expert Panel Report 3 (EPR3): Guidelines for the Diagnosis and Management of Asthma.
Writer Bio
Dr. Matthew Fox graduated from the University of California with a Bachelor of Arts in molecular, cell and developmental biology and received a M.D. from the University of Virginia. He is a pathologist and has experience in internal medicine and cancer research.