Table 1—

Severity classification and treatment recommendation for the 1997 National Institute of Health asthma guideline

Severity classification#Medication recommendations
Class 1Symptoms: ≤twice a weekInhaled SABA when needed
Asymptomatic and normal PEF between Salbutamol 100–400 µg or
 exacerbations Terbutaline 250–500 µg or
Exacerbations brief Fenoterol 200 µg
Night time symptoms: twice a month
Lung function: FEV1 or PEF ≥80% pred
Class 2Symptoms: >twice a week but <once a dayInhaled SABA and ICS
Exacerbations may affect activity Beclomethasone/budesonide 200–400 µg or
Night time symptoms: >twice a month Fluticasone 100–250 µg twice daily
Lung function: FEV1 or PEF ≥80% pred Cromoglycate 5–10 mg four times daily may replace ICS
Class 3Symptoms: dailyInhaled SABA and ICS
Daily inhaled SABA use Beclomethasone/budesonide 800 µg or
Exacerbations affect activity Fluticasone 500 µg twice daily
Exacerbations: ≥ twice a weekor
Night time symptoms: >once a weekInhaled SABA and ICS and inhaled LABA
Lung function: FEV1 or PEF >60% and <80% pred ICS: beclomethasone/budesonide 400 µg or Fluticasone 250 µg twice daily
 LABA: salmeterol 50–100 µg or Formoterol 6–24 µg twice daily
Class 4Symptoms: continualSABA and high‐dose ICS and LABA and/or
Limited physical activity ipratropium
Frequent exacerbations ICS: beclomethasone/budesonide 800 µg or Fluticasone 500 µg twice daily
Night time symptoms: frequent
Lung function: FEV1 or PEF ≤60% pred LABA: salmeterol 50–100 µg or Formoterol 6–24 µg twice daily
 Ipratropium 20–40 µg
  • PEF: peak expiratory flow

  • FEV1: forced expiratory volume in one second

  • % pred: % predicted

  • SABA: short-acting β‐agonists

  • ICS: inhaled corticosteroids

  • LABA: long-acting β‐agonists

  • #: the presence of one or more of the features of severity is sufficient to place a patient in that category

  • an individual should be assigned to the most severe grade in which any feature occurs