These are the signs of well-controlled asthma:
- Asthma symptoms occur twice a week or less
- Rescue bronchodilator medication is used twice a week or less
- Symptoms do not cause nighttime or early morning awakening
- Symptoms do not limit work, school, or exercise activities
- Peak flow meter readings are normal or the patient’s personal best
- Both the doctor and the patient consider the asthma to be well controlled
Classification of Asthma Severity and Preferred Maintenance Treatments |
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Classification |
Symptom Frequency |
Children Age 5 Years and Younger: Recommended Treatment |
Children Older Than 5 Years: Recommended Treatment |
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Mild intermittent |
At least 2 days per week. At least 2 nights per month. |
No daily medication. |
No daily medication. If severe attacks occur, systemic corticosteroids recommended. |
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Mild Persistent |
More than 2 days per week, but less than once per day. More than 2 nights per month. |
Preferred treatment: Low-dose inhaled corticosteroids with nebulizer, or MDI with holding chamber with or without face mask. Alternative treatment: Cromolyn or leukotriene-antagonist. |
Preferred treatment: Low-dose corticosteroids. Alternative treatment: Cromolyn, leukotriene modifier, nedocromil, OR sustained release theophylline. |
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Moderate Persistent |
Daily daytime symptoms. More than 1 night per week. |
Preferred treatment: Low-dose inhaled corticosteroids and long-acting beta2-agonists OR medium-dose inhaled corticosteroids. Alternative treatment: Low-dose inhaled corticosteroids and either leukotriene receptor antagonist or theophylline. If needed (especially if severe attacks occur): Medium-dose inhaled corticosteroids and long-acting beta2-agonists; medium-dose inhaled corticosteroids and either leukotriene receptor antagonist or theophylline. |
Preferred treatment: Low-to-medium dose inhaled corticosteroids and long-acting beta2-agonists. Alternative treatment: Low-to-medium dose inhaled corticosteroids and either leukotriene receptor antagonist or theophylline, or increased medium dose inhaled corticosteroids. If needed (especially if severe attacks occur): Increase dosage of medium-dose inhaled corticosteroids with add-on long-acting beta2-agonists. Alternatively, increase dosage of medium-dose inhaled corticosteroids plus either leukotriene receptor antagonist or theophylline. |
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Severe Persistent |
Continual daytime symptoms. Frequent nighttime symptoms. |
Preferred treatment: High-dose inhaled corticosteroids and long-acting beta1-agonists plus (if needed) oral corticosteroids. |
Preferred treatment: High-dose inhaled corticosteroids combined with long-acting inhaled beta2-agonists. Add, if needed: Oral corticosteroids. Repeat attempts should be made to reduce use of systemic corticosteroid and maintain control with inhaled corticosteroid. |
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Adapted from National Asthma Education and Prevention Program (NAEPP) Expert Panel Report: Guidelines for the Diagnosis and Management of Asthma – Update on Selected Topics 2002 (EPR-2 Update). |
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