Types & Severity

Types of Asthma

1. Allergic asthma. This is the basic, and the most troublesome, type of asthma and is caused by allergies. Symptoms can either be seasonal, year-round, occur randomly or only at night, depending on what you are allergic to and when you are exposed to it. A person with this type of asthma can also react during exercise or colds as with the two types below.
2. Exercise-induced bronchospasm (EIB). This type is much less troublesome on a day-to-day basis as it only occurs during or after exercise. There is usually no allergic cause. Exercise simply triggers the airways to constrict. The child is generally well when not exercising.
3. Reactive airway disease. This is actually not considered a form of asthma, but it looks and acts similarly to asthma. In this type, the child has asthma attacks only during colds. The lungs are hypersensitive to cold viruses, causing the airways to constrict. The child is generally well in between colds.
4. Other causes. There are several other causes to mention here:
   • Heartburn or reflux asthma. Here the trigger for constriction of the airways is stomach acid coming up into the throat and then going down into the lungs. You may not necessarily have heartburn pain. The symptoms generally occur after eating. You can have this type along with any of the above types.
   • Stress-induced asthma. Stress can trigger the airways to constrict. This generally occurs along with one of the above causes as well, not by itself.

Levels of Severity

Once the doctor has obtained a detailed medical history, run some tests, and diagnosed you as having asthma, your asthma will be classified. This helps determine the treatment plan. There are four levels of severity:

Mild Intermittent:

• Day: symptoms twice a week or less
• Night: symptoms twice a month or less
• Spirometry results are at least 80% of normal
• Bronchodilators recommended for short-term relief in all patients – only medication needed for this group.

Mild Persistent

• Day: symptoms more than twice a week
• Night: symptoms are more than twice a month
• Spirometry results are at least 80% of normal
• Low-dose inhaled glucocorticoids or alternatively, an oral leukotriene modifier, a mast-cell stabilizer, or theophylline may be administered.

Moderate Persistent

• Day: symptoms occur every day
• Night: symptoms are more than once a week
• Spirometry results are between 60% and 80% of normal
• Higher dose of glucocorticoid in conjunction with a long-acting inhaled β-2 agonist may be prescribed; alternatively, a leukotriene modifier or theophylline may substitute for the β-2 agonist.

Severe Persistent

• Day: symptoms are continual every day
• Night: symptoms are frequent
• Spirometry results are 60% or less of normal
• Oral glucocorticoids may be added to the above treatments during severe attacks.

Regardless of the patient’s asthma classification, any single asthma episode can range from mild to severe. This is true for anyone with asthma.