Classification of Asthma Severity*
Components of Severity | Intermittent | Mild Persistent | Moderate Persistent | Severe Persistent |
|---|---|---|---|---|
Symptoms and risk measures | All ages: ≤ 2 days/week | All ages: > 2 days/week, not daily | All ages: Daily | All ages: Throughout the day |
Nighttime awakenings | Adults and children ≥ 5 years: ≤ 2 times/month Children 0–4 years: 0 | Adults and children ≥ 5 years: 3–4 times/month Children 0–4 years: 1–2 times/month | Adults and children ≥ 5 years: > 1 time/week but not nightly Children 0–4 years: 3–4 times/month | Adults and children ≥ 5 years: Often 7 times/week Children 0–4 years: > 1 time/week |
Reliever use†, ‡ for symptoms (not to prevent EIB) | ≤ 2 days/week | Adults and children ≥ 5 years: > 2 days/week but not daily Children 0–4 years: > 2 days/week but not daily | Daily | Several times per day |
Interference with normal activity | None | Minor limitation | Some limitation | Extreme limitation |
FEV1 | Adults and children ≥ 5 years: > 80% Children 0–4 years: Not applicable | Adults and children ≥ 5 years: > 80% Children 0–4 years: Not applicable | Adults and children ≥ 5 years: 60–80% Children 0–4 years: Not applicable | Adults and children ≥ 5 years: < 60% Children 0–4 years: Not applicable |
FEV1/FVC | Adults and children ≥ 12 years: Normal† Children 5–11 years: > 85% Children 0–4 years: Not applicable | Adults and children ≥ 12 years: Normal† Children 5–11 years: > 80% Children 0–4 years: Not applicable | Adults and children ≥ 12 years: Reduced 5%† Children 5–11 years: 75–80% Children 0–4 years: Not applicable | Adults and children ≥ 12 years: Reduced > 5%† Children 5–11 years: < 75% Children 0–4 years: Not applicable |
Risk of an asthma exacerbations requiring oral glucocorticoid bursts¶ | 0–1/year | Adults and children ≥ 5 years: ≥ 2/year Children 0–4 years: ≥ 2 in 6 months or wheezing ≥ 4 times/year lasting > 1 day AND risk factors for persistent asthma | More frequent and intense events indicate greater severity | More frequent and intense events indicate greater severity |
* Severity is categorized based on degree of impairment and risk of exacerbations requiring oral glucocorticoids. Impairment is assessed over the previous 2–4 weeks, and risk is assessed over the past year. After controller therapy is initiated, severity should be assessed by the level of treatment required to maintain adequate control. | ||||
† Evidence for airflow obstruction is based on an FEV1/FVC ratio less than expected normal values by age group. Normal FEV1/FVC ratios by age group: 8–19 years = 85%; 20–39 years = 80%; 40–59 years = 75%; 60–80 years = 70%. | ||||
‡ Relievers, also called rescue inhalers, include a short-acting beta-2-agonist, an inhaled glucocorticoid plus a short-acting beta-2-agonist, or an inhaled glucocorticoid plus a long-acting beta-2-agonist. | ||||
¶ At present, there are inadequate data to correlate frequencies of exacerbations with different levels of asthma severity. In general, more frequent and intense exacerbations (eg, requiring urgent, unscheduled care such as visits to the emergency department, hospitalization, or intensive care unit admission) indicate greater underlying disease severity. For treatment purposes, patients with ≥ 2 exacerbations in the preceding 12 months may be considered to have persistent asthma. | ||||
EIB = exercise-induced bronchoconstriction; FEV1 = forced expiratory volume in 1 second; FVC = forced vital capacity; ICS = inhaled corticosteroid (glucocorticoid); SABA = short-acting beta-2 agonist. | ||||
Adapted from National Heart, Lung, and Blood Institute: Expert Panel Report 3: Guidelines for the diagnosis and management of asthma—full report 2007. August 28, 2007. Available at http://www.nhlbi.nih.gov/guidelines/asthma/asthgdln.htm and Expert Panel Working Group of the National Heart, Lung, and Blood Institute (NHLBI) administered and coordinated National Asthma Education and Prevention Program Coordinating Committee (NAEPPCC), Cloutier MM, Baptist AP, et al: 2020 Focused Updates to the Asthma Management Guidelines: A Report from the National Asthma Education and Prevention Program Coordinating Committee Expert Panel Working Group [published correction appears in J Allergy Clin Immunol 2021 Apr;147(4):1528-1530. doi: 10.1016/j.jaci.2021.02.010]. J Allergy Clin Immunol 146(6):1217–1270, 2020. doi:10.1016/j.jaci.2020.10.003.. | ||||
For additional information, see Global Initiative for Asthma. Global Strategy for Asthma Management and Prevention, 2025. Updated May 2025. Accessed May 20, 2025. Available from www.ginasthma.org | ||||