How do you classify the different degrees of asthma. I see on this site people mentioning mild/moderate/severe, and brittle, but they are not all necessarily on the same level of medication within the same category. Is there a recognised system?
Yvonne (confused)
Hi Yvonne,
As far as I'm aware, there aren't strict definitions for mild, moderate and severe asthma. The British Thoracic Society guidelines for asthma define five steps in the treatment of asthma:
Step 1: Mild intermittant asthma
Inhaled short acting beta 2 agonist as required.
Step 2: Regular preventer therapy
Add inhaled steroid 200 - 800 micrograms/day
400 micrograms is an appropriate starting dose for many patients
Start at dose of inhaled steroid appropriate to severity of disease.
Step 3: Add-on therapy
1. Add inhaled long acting beta 2 agonist (LABA)
2. Assess control of asthma:
- good response to LABA - continue LABA
- benefit from LABA but control still inadequate - continue LABA but increase inhaled steroid dose to 800 micrograms/day (if not already on this dose)
- no response to LABA - stop LABA and increase inhaled steroid to 800 micrograms/day. If control still inadequate, institute trial of other therapies, eg leukotriene receptor antagonist or SR theophylline
Step 4: Persistent poor control
Consider trials of:
- increasing inhaled steroid upto 2000 micrograms/day
- addition of a fourth drug, eg leukotriene receptor antagonist, SR theophylline, beta 2 agonist tablet
Step 5: Continuous or frequent use of oral steroids
Use daily steroid tablets in lowest dose providing adequate control.
Maintain high dose inhaled steroid at 2000 micrograms/day
Consider other treatments to minimise use of inhaled steroids.
Refer patient for specialist care.
The dose of the inhaled steroid is given for beclomethasone - it varies for other inhaled steroids.
Don't worry if your doctor has not proceeded along these steps exactly as they are given here - remember that they are only guidelines, and that individual doctors have individual experiences of different drugs. Also some drugs might be particularly suitable for particular people - for example, leukotriene antagonists are particularly good for allergic asthma, exercise induced asthma and asthma associated with nasal polyps and aspirin allergy (Samter's triad).
Some people with severe or brittle asthma who are looked after by a hospital consultant will be on other treatments in addition to the ones above - 'Step 6' as one of my consultants used to refer to it, although officially there isn't a step 6.
Brittle asthma is an expression which has been used since 1977 to mean various different forms of severe or difficult to control asthma. More recently it has been used to describe asthmatics who are at increased risk of severe or life threatening attacks - two main patterns of disease have been identified and defined as brittle asthma:
Type 1 - characterised by wide peak flow variability (>40% diurnal variation for >50% of the time over a period of at least 150 days) despite high levels of medical therapy including a dose of inhaled steroids of at least 1500 micrograms of beclomethasone (or equivalent)
Type 2 - characterised by sudden acute attacks occurring in less than three hours without an obvious trigger on a background of apparent normal airway function or well controlled asthma
Not everyone with a diagnosis of brittle asthma or with brittle elements to their disease meet these strict definitions, and a lot of us who meet the criteria for Type I brittle asthma also have sudden onset 'Type 2' type attacks.
I think that it's also important to realise that brittle asthma isn't necessarily any 'worse' than severe asthma that doesn't meet the criteria above. There are a lot of people who don't fulfil the definition of brittle asthma who nevertheless have severe, disabling asthma with chronically low peak flows and poor exercise tolerance.
We are all in the same boat basically whether mild, moderate, severe or brittle, and I think we can all relate to the fear and anxiety caused by feeling breathless. Whether we are worried about our first use of inhaled steroids, the first time we have had to go to A&E for a nebuliser, or the first time of being ventilated, we all need the support of others on the site and we all have things to offer others on the site.
I put that last little digression in because sometimes I think defining the steps above can make people feel that they are somehow less justified in their worry about their asthma, or less worthy of the support of others. Personally I wouldn't want anyone to feel like that - one doesn't have to be at a certain level, or even necessarily have a diagnosis of asthma, to want or need support from this site.
Anyway hope the above has answered your question a little Yvonne, or perhaps it has confused you more!
Take care all
Em H
Poggins
Please dont focus on classification of asthma, please use this site as Emily has so eloquently put it we all need support. There are a few of us who dont have classical asthma on here, and even a few of us who dont have asthma diagnosis. But we are here because we need support, friendship and a shoulder to cry on. Please feel free to ask questions or just join in our conversations. We have medics here and we have patients who in the area of asthma could be better qualified than most medics. They can answer your quests or put you in the right direction to get answers. But the main reason for being here is support. We hope you join us and get to know us.
classification of asthma
Thank you Emily for your comrephensive explanation, I was aware of the step system for the treatment of asthma, but not quite in that detail. This is obviously a more accurate way of classsifying asthma but people don't seem to refer to there asthma by this method.
I was just curious as I could not find any other information regarding classification categories.
Thank you for taking the time to explain in such detail.
Yvonne
Hi Bowmei
Thank you for your friendly advice. I have found this site really helpful of late and have 'met' some lovely people here. The asthma nurse advice line I have found of great benefit too. Like you say we are all in the same boat and a little friendly support goes a long way especially when you feel like dipping your head in a deep bucket of water.
Thanks for the reply
Yvonne
Or there is the offical mad scale:
Mad
Mad as hatters
Mad as Toast
Mad as eggy bread
Bex
I'm at *least* as mad as eggy bread!
Glad to see I'm in good company then - I use the 'Friggin' method of categorisation myself.
Friggin fed-up
Friggin fed-up of coughing
Friggin fed-up of shaking
Friggin Friggin fed-up of not being able to do what I want to do when I want to do it.
Feel Friggin better now - phew. honest. Apologies - thank you for listening.
asthma exacerbation
PEP for asthma
In hospital with asthma 
asthma and the seaside
