Asthma UK community forum
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What do the Steps of asthma mean?

I went to the doctors today and had my usual review and after hearing the medicine I am on the nurse said ""oh so you're on Step 4"" to which I just said I don't know. I have heard mention of ""steps"" of asthma a few times for different nurses but don't know why it's ranked in steps when they steps aren't used by everyone. Is it an old fashioned method?

13 Replies

ah I have found something. This suggests if I got any worse then the only way to go is oral steriods. I knew this and have them prescribed at the ready in case I need them.

As I am Step 4, it seems strange that there is only Step 5 above this when I know a lot of people on this forum are a lot worse than me, all varying degrees, surely there should be more Steps/treatments available higher up.

Then again I guess the majority are in Step 1-2. I don't know anyone above Step 2 except my AUK friends I don't think. So I guess proportionally this is accurate and just a rough guide.


Im told Im well off the scale! I was Step 4-5 as a teenager, then step 2 but not brilliantly controlled early 20s, Step 3 with complete control for 5yrs and now at nearly 34 Im on the escilator as the steps make me breathless, lol!

I do think its worth mentioning that about the disproportionate number of severe and/or brittle asthmatics on this forum, as I sometimes think we might scare those with milder symptoms.


I was on 4 for ages and now seem to have snuck up to 5 as I can't get off pred. 1 or 2 when younger though not sure how well controlled I was -way better than now but my mum remembers it as a bit worse than me and I wonder if they just had different attitudes to treatment then?

Defo agree milder asthmatics might be scared. I still vaguely think of myself as being moderate though that may be pushing it if uncontrolled on step 5. This forum is not so good for me at times though as I measure myself against all the people here who are much worse than me and think it's totally normal to have loads of symptoms before I even think about doing anything!


oh no sparkly. it seems people can get worse for no reason at all, do people who are step 5 randomly get better just like people who are below randomly get worse?

For me I think it helps to put it in perspective and I should be grateful of the things I can do instead of being all ""boohoo"" about asthma like I can be sometimes.

Philomela that sucks, hope you can manage to get off it. my body seems to adjust to whatever level of med I'm on but I hope it doesn't this time as this is the best I've been in a while. I like being able to have the ""severe"" label on asthma - not that I want severe asthma but it helps in explaining how serious it can be to people and helps them understand it isn't the usual ""step 1"" asthma that people come across day to day.

I do understand what you mean though, last year I got so used to be ill every day I forgot what it was like to not be(became normal for me). Think it took a lot of people getting worried about me helped me realise I needed things to change. In fact on the phone the other day I told my Dad that I played netball the other day and he was like ""wow you couldn't have done that a few months ago could you!"" It was nice that he recognised the difference.


Well I'm dropping now, been on for a couple of months this time up and down but they're protesting about being at 25mg! Doing slow taper, I want my face back (cons tactlessly and GP rather more nicely said the pred is showing)...but they're not liking it.

Agree re having the label - mine is 'difficult' hehe which is pretty accurate atm.

Yay re you being better and playing netball, it is good when you suddenly realise you can do things, I had time like that in August, was so nice and I want to get back there! I know what you mean about adjusting - I feel like they're the Borg and adapt to the weapons I throw at them! (sorry Trekkie geek here hehe).


What do you mean by ""want your face back""?

Yes it's brilliant. I think I appreciate it more because I was so bad in August I couldn't walk down the road without getting out of breathe, kept me up every night, on pred which isn't usual for me. was not good! so now I'm appreciating things people take for granted. I hope you get back there soon Philomela!!! I always seem to be ill at xmas so fingers crossed I'm OK this year.

Ha I got the Borg reference - my Dad and brother watched it so I'm very familiar. I actually don't think star trek is that bad.

I always wonder what would happen without the meds... would be like a countdown until bad things happen. My flat mates told me in a survival of the fittest situation I'd be dead already - ha


My face has gone all steroidy and round! Cons said 'oh I could tell you were on steroids right away' - thanks a bunch. GP said 'do you think the steroids are affecting you?' and I said if you mean my face I know. And in other ways too. ugh.

Fingers crossed for you too re Xmas! Defo agree we appreciate it more...

I think these days I might just end up in hosp and not able to do much, don't think would kill me but would be nasty. I wasn't on them for ages actually while they faffed with diagnosis and I couldn't do much and got really tired. I suspect I may have got slightly worse since then though - I was never in hosp till this year and been in a few times now though never really bad attacks.


I didn't realise it could happen so quickly. The steriods are notorious for their horrid side effects aren't they. When I was first on them two years ago (only for 5 days) no one warned me of any side effects. When I went back to the nurse following week she asked me if I was eating a lot and not sleeping and I was like ""yes, how did you know?"" and she told me it was the steriods. I'd been ravenous all week and had terrible insomnia. My boyfriend at the time kept telling me to relax and go to sleep but I kept explaining it was impossible. So it all made sense when she said that.

Annoying re the faffing around. I was thinking to myself last night that I seem to have quickly gone from step 1(at age 17 when first diagnosed) to step 2 pre-uni, then step 3 up until now but I think I have been step 4 for a while but everyone has been faffing with me too - didn't wanna give me the dose I needed until they'd done loads of tests on me etc.


Although dreadful in my teens, in my late 20s I was able to run marathons and become a fitness instructor doing up to 12hrs a day hard exercise, so definately possible to improve. Almost exactly a year ago it got terrible literally overnight -Dec 16th to be precise!! Its gone downhill since, and goodness knows where Id be without all these meds, but Ive been told the fact it got bad suddenly means theres more chance of it improving again, possibly equally suddenly.


I agree re diagnosis too. Even tho Id pretty much figured it out myself, it was still a shock to be dx brittle, esp as I found out as I was handed over from outpatients to acute care on my first clinic kidnapping - no one had actually told me directly. I feel more comfortable saying I have brittle asthma than really bad asthma, which doesnt really say much. I used to think my asthma was really bad if I needed salb every day, now I need 10puffs before I can get out of bed!


Asthma is very variable... sometimes I wish it would just be consistent so I would know what is going on but then again I wouldn't want it to be consistently bad. I hope you improve soon Sparkly.

Everyone in my family seemed to develop some sort of allergy at my age and that they got ill a lot (as in with colds etc.) so I guess my asthma was just dormant until this age. Their allergies also improved so hopefully mine will too however I do not think the asthma will ever go away completely.

Yes brittle asthma I guess is easier to understand as a level of asthma rather than someone thinking its just your own perception of asthma as ""really bad"". A few weeks ago I told someone that I have severe asthma and they replied ""no you don't"" and I had to argue that I actually do. Must be because I am well at the moment and even when I'm ill you can't really tell - I just look tired.


I have always found the steps a good way to measure the severity of my asthma at any time and yes it is possible to go randomly up and down. I never been at step 1 but was on brown inhaler as a very young child then ended up at step for and five and in my teens. I was regularly in hospital for long periods of time but my asthma improved rapidly from age 17-18. While at uni, I managed to get to step three (technically tried 2 but it didn't last long) and have now been at step four for the past 3/4 years (in my early thirties now) but not controlled at this level.

As for labels mine is severe allergic asthma (cough predominant). The best part of this has been the cough predominant (which was about the only useful thing my cons did for me) as when OOH, new doctors see this, they can't argue with the fact that I am not wheezy. It has made getting help slightly easier.


I know I have allergies but I never really notice them, only showed up on tests. When I am around allergens they tend to hit me over time rather than straight away ie. if around dust I might not notice any symptoms straight away - seems to build up.

Also I am not much of a cougher which seems weird as most people on here seem to have crazy coughs when their asthma is flaring up. Even when I have loads of phlegm on my chest I don't seem to cough, just comes up on its own. I don't think I wheeze either which I guess is annoying when trying to seek help. I get the whole tightness in chest, struggling to breathe but miss out on some of classic symptoms.

Glad getting help has been made easier for you. Oh dear about the cons - that bad?


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