Asthma is a chronic respiratory condition characterized by inflammation and narrowing of the airways, which leads to symptoms like wheezing, coughing, and shortness of breath. This inflammation makes the airways overly sensitive to various triggers, causing them to spasm and restrict airflow. A significant number of people have “persistent asthma,” meaning the underlying disease process requires ongoing, daily attention to prevent frequent and potentially serious flare-ups.
Defining and Identifying Persistent Asthma
Persistent asthma is clinically defined by a measurable frequency and intensity of symptoms. A diagnosis is established when daytime asthma symptoms occur more than twice per week, or when nighttime symptoms lead to awakening more than two times per month.
The frequency of needing a short-acting bronchodilator, often called a rescue inhaler, also contributes to the diagnosis. If a person requires this quick-relief medication more than twice a week for symptom management, it indicates persistent disease activity. Identifying persistence prompts healthcare providers to initiate regular, preventative treatment to stabilize the airways and reduce the risk of future severe attacks.
Categorizing Levels of Severity
Once asthma is classified as persistent, its severity is further categorized into mild, moderate, or severe. Mild persistent asthma presents with symptoms more than twice a week but not daily, and nighttime awakenings occur three to four times a month. Lung function tests, such as forced expiratory volume in one second (FEV1), are 80% or greater of the predicted value in this category.
Moderate persistent asthma involves daily symptoms and nighttime awakenings that occur more than once per week, though not every night. The disease starts to affect daily activities, and lung function tests show a reduction, with FEV1 values falling between 60% and 80% of the predicted healthy value.
Severe persistent asthma is characterized by symptoms that occur throughout the day and severely limit physical activity. Nighttime symptoms are frequent, often occurring every night. Patients in this category have compromised lung function, with FEV1 measurements consistently at or below 60% of the predicted value.
Strategies for Daily Control and Management
The primary objective in managing persistent asthma is to achieve long-term control, meaning minimal symptoms and the prevention of future exacerbations, accomplished through the regular use of controller medications. Inhaled corticosteroids are the most common form of controller, taken daily to reduce swelling and mucus production within the airways.
Controller medications are distinct from rescue medications, such as short-acting beta-agonists, which are used only as needed to quickly open the airways during a symptom flare-up. For patients with persistent asthma, long-acting bronchodilators may also be added to the daily regimen to provide sustained airway opening.
A written Asthma Action Plan, developed with a healthcare provider, is an important tool for daily management. This plan outlines specific steps for the patient to follow based on symptom severity, often using a color-coded system (green for well-controlled, yellow for caution, red for emergency). Identifying and avoiding personal triggers, such as pollen, smoke, or pet dander, along with regular monitoring of symptoms and lung function, contributes to stable respiratory health.