Table 5—

Classification of asthma severity

Lowest level of treatment required to achieve patient's best level of asthma controlSABA as neededLow-dose ICS or other low-intensity treatment (e.g. cromolyn, LTRA, nedocromil and theophylline)#Low- to moderate-dose ICS and LABA (or other extra treatment)#High-intensity treatment (high-dose ICS and LABA ± oral corticosteroids and/or other extra treatment)#
  • See also fig. 1. Modified from the Expert Panel Report 3 of the National Heart, Lung, and Blood Institute 6, with step numbers replaced by medication class names. Severity is based on the intensity of treatment required to control the patient's asthma once the diagnosis has been confirmed, comorbidities treated, and inhaler technique and adherence have been optimised. Down-titration should be performed, if possible, to avoid misclassification due to over-treatment. The description of treatment intensity is based on the medications and doses recommended in the stepwise treatment algorithm found in current guidelines 1, 2. It is acknowledged that not all of these medications will be available in all healthcare systems, and that this may affect the assessment of asthma severity in some environments. It is not yet known how new approaches, such as initial maintenance therapy with inhaled corticosteroids (ICS)/long-acting β2-agonists (LABA), or maintenance and reliever therapy (e.g. with budesonide/formoterol), will be positioned in asthma guidelines, and hence how they will affect the classification of mild/moderate asthma. However, the same principle, of mild asthma being defined by the ability to achieve good control using very low-intensity treatment and severe asthma being defined by the requirement for high-intensity treatment, will still be applicable. SABA: short-acting β2-agonist; LTRA: leukotriene receptor antagonist. #: see guidelines for details 1, 2.