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Asthma Stages

author image Matthew Fox, MD
Dr. Matthew Fox graduated from the University of California with a Bachelor of Arts in molecular, cell and developmental biology and received a M.D. from the University of Virginia. He is a pathologist and has experience in internal medicine and cancer research.
Asthma Stages
A doctor helping a young boy use an inhaler. Photo Credit LeventKonuk/iStock/Getty Images


According to the Mayo Clinic, asthma is a disease characterized by constricting airways, swelling and mucus production in response to environmental triggers. The National Institutes of Health classifies asthma based on four stages created to help health-care practitioners treat asthma. Regardless of stage, the mainstays of treatment include medications, environmental control, patient education and ongoing adjustments to treatment as needed.

Stage 1

The first stage of asthma is called "intermittent" because symptoms such as wheezing come and go. This stage is defined by symptoms occurring no more than two times per week and nighttime awakening occurring no more than twice per month. There is no interference with normal activity and normal lung function. Inhaler use is less than three days per week. Suggested initial treatment is with a short-acting inhaler such as albuterol as needed. Albuterol is a "beta agonist," a class of drugs that dilates the airways when inhaled.

Stage 2

Stage 2 asthma is called "mild persistent." It is characterized by symptoms that occur greater than two days per week but not daily, and three to four nighttime awakenings each month. Inhaler use may be greater than two days per week, although not on a daily basis, and not more than one time per day. There may be minor limitation in normal activity. Treatment includes a short-acting beta agonist rescue inhaler as in the first stage and also adds a long-acting medication, usually inhaled steroids to suppress the overactive immune response in the lungs.

Stage 3

Stage 3 asthma is called "moderate persistent." In this stage, the asthmatic will have daily symptoms of asthma, nighttime awakenings more than once per week, daily need of short-acting rescue medication, some limitation in normal activity and decreased lung function. Treatment at this stage is either a low-dose inhaled steroid and a long-acting beta agonist. Alternatively medium-dose inhaled steroids may be used in addition to a short-acting beta agonist such as albuterol.

Stage 4

Stage 4 asthma is known as "severe persistent asthma." Symptoms occur throughout the day, and nighttime awakening may occur every night. The asthma attacks severely limit normal activity. A short-acting rescue drug may be required several times per day. Lung function is noticeably reduced. Treatment is high-dose inhaled steroids and a long-acting beta agonist. If that does not control the symptoms, oral steroids are added. Alternative drugs are available at all stages, as are allergy shots if the asthma is a result of general allergies.

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