5. Asthma Severity and Asthma Control

Severity and control are two different assessments for a child’s asthma. Definitions of severity and control will be reviewed in this section. Tables summarizing the management of asthma based on severity and control are linked below:

• Asthma Stepwise Table
• Asthma Follow-up Table

Control

The degree to which the manifestations of asthma are minimized by therapeutic interventions and the goals of therapy are met.

Assessing asthma control

Asthma control focuses on two domains:

1. Reducing Impairment – the frequency and intensity of symptoms and functional limitations, interference with activity of daily living, or decreasing morbidity.
2. Reducing Risk – the likelihood of future asthma exacerbations or acute care visits (ED, Urgent Care, or hospitalizations), progressive decline in lung function (or reduced lung growth in children), or medication side effects.

Quality asthma care involves not only initial diagnosis and treatment to achieve asthma control. Addressing environmental triggers, helping patients learn self-management skills, and long-term, regular follow- up care are also necessary to maintain control.

Asthma control, compliance/adherence to medications, limitations to asthma care, triggers, and patient/family expectations should all be assessed at each follow-up visit.  

• Asthma Control Test - Adult
• Asthma Control Test - Adult (Spanish)
• Asthma Control Test - Child
• Asthma Control Test - Child (Spanish)
• TRACK 0-4 year olds
  
  

Severity

Asthma severity is defined as the intrinsic intensity of the disease process.

Assessing Asthma Severity

EPR

• Intermittent
• Mild Persistent
• Moderate Persistent
• Severe Persistent

These categories are based on impairment and risk and level of symptomatology varies by age. Severity should be categorized by symptoms and level of inhaled corticosteroid controller medications during the initial visit.

GINA 2020

• Mild Asthma (Step 1 and 2)
• Moderate Asthma (Step 3 and 4)
• Severe Asthma (Step 5)

These categories are based on the level of treatment required to control symptoms and exacerbations.

Risk factors

Risk factors for poor asthma outcomes such as co-morbidities, exposures, and socioeconomic barriers are discussed in section  7. Treating Modifiable Risk Factors.