So, now that we’ve discussed a bit about what asthma is, how it works, and what it looks like, why don’t I explain how asthma is classified? You’ve seen me toss around terms like “mild intermittent” “moderate” and “severe” here, but what do those terms mean? How do we classify asthma?
And some more recent classification schemes include a fifth category either below or above the current severe category as “severe” encompasses too wide a range of severity to really be useful now that treatment has improved, so the fifth category was introduced to provide a more useful classification. The Canadian guidelines use “very severe,” which as it sounds is more severe than severe asthma. Under these recent Canadian guidelines, I’m classified as a severe asthmatic, but internationally, I’d be more likely to be classified as a moderate asthmatic, so that’s what I tend to use on the blog, lest I give people the wrong impression.
With the severity model, it is important to remember that doctors pick the most severe category you fit at least one criterion of. This is to prevent under-estimating a person’s severity and under-treating them (something that happened to me back when my asthma was starting to get bad again). So when you’re reading the descriptions of severity categories, remember that any one of the things I list put you in the next category up. Or, as my doctor says, “You take the worst of pulmonary function, symptoms, and medication needs, and that’s your severity.” Another important thing is that symptoms listed are what your symptoms are like without any treatment. So if you were off meds entirely, this is how bad your asthma would be. For simplicity, I’ll use the common international classifications in this post, but you can look up your country’s classification scheme if you’re curious – most countries I’ve searched post them online.
Mild intermittent asthma is defined as asthma where people experience symptoms no more than twice a week, wake up no more than twice a month, need their quick-relief puffer no more than twice a week, don’t have asthma interfere with daily activities at all peak flow and pulmonary function are normal between attacks, and asthma flares only rarely (<1/yr) require oral steroids. People with mild intermittent asthma can go weeks, months, or even years between significant flareups. Mild intermittent asthmatics need only a rescue inhaler to achieve good control.
Mild persistent asthma happens when people experience symptoms more than twice a week but not daily, or wake up 3-4 times a month, or use their quick-relief inhaler more than twice a week but not daily, or have minor limitations of daily activities without treatment or have peak flow readings of 80-100% between fares, or need oral steroids 2+ times a year. Mild persistent asthmatics are able to achieve good control, but need daily maintenance therapy, usually with low- to moderate-doses of inhaled corticosteroids.
Moderate persistent asthma happens when someone has daily symptoms, or wakes up more than once a week, or needs their quick relief puffer daily, or has some limitations of daily activity, or has peak flow of 60-80%, or peak flow variability of 15-30%, or asthma flares need oral steroids twice a year. Moderate persistent asthmatics are able to achieve good control, and are treated with high-dose corticosteroids, with or without other treatment.
Severe persistent asthma happens when someone has symptoms all day, or wake up every night, or need their inhaler several times a day, or limits activities daily, or have peak flow of <60%, or have peak flow variability of >30%, or need steroids for asthma several times a year. Severe asthmatics may or may not be able to achieve good control, always need other treatment in addition to high-dose corticosteroids. Many severe asthmatics need daily oral steroids.
Because it’s dangerous to take someone off their meds to see how bad their asthma is, in Canada, we’ve started categorizing severity based on how much meds you need to achieve control and whether or not you’re able to achieve textbook control.
The next post in this series may be found here.
So, as you’ve learned from my previous post, asthma is a lung disorder characterized by chronic, reversible airway obstruction due to lung inflammation and bronchospasm. But what does that mean in terms of how it looks on the outside? What does it make a person do or feel?
That’s what I’m going to talk about today: Asthma symptoms.
Wheezing is what happens when your lungs are tight enough that when you breathe out it makes a whistling sound. The whistling sound may be quiet or loud. Wheezing is always a sign of airway obstruction, even if it’s not caused by asthma. Asthmatics vary greatly in how much we wheeze, and sometimes we don’t wheeze much at all. Some asthmatics I’ve met describe wheezing as feeling like a rubbing feeling in their chest, whereas for me it feels more like a deep vibration. Others say they don’t really notice what wheezing feels like.
Coughing is, well, coughing. It happens when your cough reflex is triggered. It may or may not be a sign of airway obstruction, but it’s a sign of airway inflammation. Asthmatic people – particularly those with cough-variant asthma – tend to cough a lot. You may or may not cough up gunk (the medical term for this gunk is sputum) when you have asthma. Sputum is often clear between and during attacks and may look pus-like afterwards. An asthma cough is a deep, chesty cough that often but not always is loud. It’s not the little “ahem-ahem” they sometimes show on TV. Asthma coughs rock your whole body and can cause things like pulled muscles because you’re coughing so hard. Think less “I have a mild cold” and more “bronchitis”. In fact, asthma is often misdiagnosed as recurring episodes of acute bronchitis, especially in mild intermittent asthmatics, who may go months or years between symptoms.
Shortness of breath is a thing that I prefer the alternative name of: air hunger. Air hunger is far more descriptive and accurate than the shortness of breath name. It’s that feeling that you can’t get enough air, and to me it’s the single most unpleasant asthma symptom out there. It is a fundamentally different feeling from that normal people get when they work out too hard, and one that’s hard to describe. It’s one of those things that if you’re not sure whether or not you’ve ever experienced it, you haven’t. When you’re air hungry you know. Everything in your body screams, “must get air” and you can’t, like the proverbial person stuck on a life raft in the middle of the ocean. Air, air, everywhere, so why can’t I breathe?
Chest tightness is a catch-all term for dull chest pain, chest discomfort, and chest pressure. It is a general term for discomfort in the general chest area without another explanation and that doesn’t fall under some other category like a pulled muscle or the crushing pain of a heart attack. I pretty much always have some degree of chest tightness. I’m kind of used to it. For me, chest tightness feels like that burning chest feeling you get if you’ve spent too long at the bottom of the pool. Others describe it as feeling like an iron band is around their chest. I couldn’t find a good description link for chest tightness because it is a rather vague and ill-defined term.
The above is by no means an exhaustive list. Asthma symptoms are as varied as people with asthma, and each person who has it should keep a symptom diary until they figure out what their early warning signs are.