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STEPS - Classification of Asthma Severity

Clinical features before treatment.

Nighttime
Classification Symptoms Lung Function
Symptoms
 Symptoms less than twice
 FEV1 or PEF
a week
greater than
 Asymptomatic and normal
80% of
STEP 1 PEF between Less than
predicted
Mild exacerbations twice a
 PEF
Intermittent  Exacerbations brief (from month
variability less
a few hours to a few days);
than 20%
intensity may vary

 FEV1 or PEF
 Symptoms less than twice
less than 80%
a week but lasting longer
STEP 2 More than of predicted
than a day
Mild twice a  PEF
 Exacerbations may affect
Persistent month variability
activity
20% to 30%

 Daily symptoms
 FEV1 or PEF
 Daily use of inhaled short-
60% to 80%
acting beta2-antagonist
of predicted
STEP 3  Exacerbations affect
More than  PEF
Moderate activity
once a week variability
Persistent  Exacerbations more often
greater than
than twice a week; may
30%
last for days

 FEV1 or PEF
less than 60%
 Continual symptoms of predicted
STEP 4
 Limited physical activity  PEF
Severe Frequent
 Frequent exacerbations variability
Persistent
greater than
30%

National Asthma Education and Prevention Program Expert Panel Report 2: Guidelines for the
Diagnosis and Management of Asthma
The presence of one of the features of severity is sufficient to place a patient in that category. An
individual should be assigned to the most severe grade in which any features occurs. The
characteristics noted in this figure are general and may overlap because asthma is highly
variable. Furthermore, an individual's classification may change over time.

Patients at any level of severity can have mild, moderate, or severe exacerbations. Some patients
with intermittent asthma experience severe and life-threatening exacerbations separated by long
periods of normal lung function and no symptoms.