After confirming an asthma diagnosis, your pediatrician will grade the severity of your child’s condition. This grading takes into account the frequency and severity of past and current asthma symptoms and the physical examination, and may include measures of lung function including spirometry or peak flow measurements. This information enables your pediatrician to select the right medication and determine the proper dose to keep the condition in check. (See “What Really Matters Is Control, Not Severity” below.) In making a decision about a child’s asthma severity level, the first distinction to be made is whether your child has intermittent asthma (ie, just occasional problems) or persistent asthma (ie, more than occasional). Patients with persistent asthma can have mild, moderate, or severe asthma. Following are more details about the 4 asthma severity levels that arise by making this kind of distinction.
What Really Matters Is Control, Not Severity
It turns out that asthma severity categories are somewhat arbitrary and, in fact, were actually created more with adults in mind than children. They are just a general guide for the doctor seeing your child; your doctor realizes that asthma severity levels, particularly in children, can change over time, so reassessments need to take place on an ongoing basis to verify an individual child’s present asthma severity. Furthermore, the 2007 National Heart, Lung, and Blood Institute “National Asthma Education and Prevention Program Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma” make a strong point that the overall control of your child’s asthma is really what is most important, not what the severity level happens to be at any time. Adjustments of treatment are based mainly on how well-controlled your child’s asthma is when assessed at follow-up visits.
A child who has symptoms of wheezing and coughing no more than 2 days a week is con-sidered to have intermittent asthma; nighttime flare-ups occur twice a month at most. Outside of these few episodes, a child with intermittent asthma is free of asthma symptoms.
Any child with asthma symptoms more often than 2 days a week or 2 nights per month, on average, is felt to no longer have intermittent asthma but persistent asthma. Persistent asthma has 3 levels of severity.
Mild Persistent Asthma
In mild persistent asthma, symptoms occur more than twice a week but less than once a day, and flare-ups may affect activity. Nighttime flare-ups occur more often than twice a month but less than once a week. Lung function is 80% of normal or greater.
Moderate Persistent Asthma
Asthma is classified as moderate persistent if symptoms occur daily. Flare-ups occur and usually last several days. Coughing and wheezing may disrupt the child’s normal activities and make it difficult to sleep. Nighttime flare-ups may occur more than once a week. In moderate persistent asthma, lung function is roughly between 60% and 80% of normal, without treatment.
Severe Persistent Asthma
With severe persistent asthma, symptoms occur daily and often. They also frequently curtail the child’s activities or disrupt his sleep. Lung function is less than 60% of the normal level without treatment. Severe is the least-common asthma level.