Moderate Persistent Asthma: Symptoms, Causes, And Management

Asthma is a lung condition that affects more than 26 million people in the US¹. Around 65% of people with asthma have moderate persistent asthma. This means they experience daily asthma symptoms and have decreased lung function.

If you've been diagnosed with moderate persistent asthma, it's important to know what that means and how that diagnosis will impact the treatment and management of your condition.

What is asthma?

Asthma is a chronic inflammatory condition² that affects the lungs. In people with asthma, the tissue in the airways becomes sensitive to certain triggers. The tissue then becomes inflamed and swollen, making breathing more difficult. This is sometimes called an asthma attack. 

Symptoms of an asthma attack might include:

• Coughing

• Wheezing

• Shortness of breath

• Tightness in the chest

There is no cure for asthma, but many treatment options can help prevent the onset of asthma symptoms. With a good treatment plan and consistent management of symptoms, most people with asthma live healthy, active lives.

Asthma classifications

Treatment of your symptoms will depend on your asthma classification. Your doctor will determine the classification of your symptoms based on their severity and frequency.

They may use lung function tests, which measure your lungs’ ability to bring air into the body. These tests will measure your forced expiratory volume in the first second (FEV1)³, which is how much air you can forcefully blow out of your lungs within one second.

A percentage result is given based on predicted normal values considering your height, age, gender, and race. The doctor will also use these results to determine your asthma severity.

Asthma classifications for people over the age of 12 include:

Intermittent asthma

• Symptoms are experienced no more than two days a week

• No interference with normal activity

• Fast-acting medications for symptom control are used no more than two days a week

Mild persistent asthma

• The symptoms occur more than twice a week but not every day

• There are some minor limitations to everyday activity

• FEV1 measures 80% or better than predicted normal values

Moderate persistent asthma

• Symptoms are a daily occurrence and frequent at night

• Asthma symptoms interfere with daily activities

• FEV1 is between 60 and 80% of predicted normal values

Severe persistent asthma

• Symptoms are a daily occurrence and frequent at night

• Daily activities are severely limited by asthma symptoms

• FEV1 is 60% or less than predicted normal values

The classification of your asthma can change over time, especially for children. Symptoms may get better or worse depending on your lifestyle, medications, or how well you can avoid certain asthma triggers.

That means these classifications aren't necessarily a permanent diagnosis, but they can help guide the treatment and management of your symptoms.

What is considered moderate persistent asthma?

Moderate persistent asthma is the most common type of persistent asthma. This means the symptoms regularly cause breathing problems. Around 64.8% of people who have asthma have moderate persistent asthma.

You might have moderate persistent asthma if:

• Flare-ups may affect the activity level

• Nighttime symptoms 5 or more times a month

• Lung function test FEV1 is above 60% but below 80% of normal values

Symptoms of moderate persistent asthma

Asthma symptoms can vary depending on your asthma type and the severity of your symptoms.

The symptoms of moderate persistent asthma are similar to other asthma classifications and may include:

• Coughing

• Wheezing

• Tightness in the chest

• Difficulty catching your breath

These symptoms may occur during the day and at night when they could disrupt your sleep.

Causes of moderate persistent asthma

It's unclear why some people develop asthma while others do not. It's likely a combination of genetic and environmental factors.

You are more likely to develop asthma if one or both of your parents have it. Exposure to certain toxic chemicals or respiratory infections could also lead to the development of the condition.

It's clearer what causes the onset of asthma symptoms, known as an asthma attack. Asthma attacks are triggered by certain stimuli, including:

• Household dust

• Pet dander

• Cigarette smoke

• Exercise

• Food allergies

• Outdoor air pollution

• Hormonal changes

• Changes in the weather

• Changes in your emotional state

Identifying your triggers and having a plan to limit your exposure to them is a key part of asthma management. This can help reduce the severity and frequency of your asthma attacks.

Diagnosis

To diagnose asthma, your doctor will start by learning more about your medical history. Your doctor may also ask about your family's medical history, which can give them insight into the probability of an asthma diagnosis.

Your doctor will also likely test your lung function and how well you can move air into and out of your lungs. These tests might include spirometry and peak flow testing. Your doctor may also recommend a chest x-ray to help rule out other medical conditions contributing to your symptoms.

If your doctor diagnoses you with asthma, they'll work with you to develop a treatment plan.

Management and treatment

There is no cure for asthma. However, many options can help you manage and treat your asthma symptoms.

The treatment will work to prevent your symptoms as much as possible and give you rescue options that can help if you have an asthma attack. The goal of your treatment plan is to slow, stop, or even reduce the decline in lung function.

Lifestyle changes

Lifestyle changes can help you avoid your asthma triggers but may also help improve your lung function. Some common lifestyle changes recommended by doctors include:

• Increasing your daily exercise: This can help strengthen your lung muscles and improve your lung function over time.

• Stopping smoking: Cigarette smoke is a common asthma trigger. Continuing to smoke may worsen your asthma symptoms due to decreased lung function.

• Losing excess weight: If you are obese, weight loss may improve your control over asthma symptoms.

Allergy medications

Allergic reactions are common asthma triggers. Allergy medications may help reduce your body's sensitivity to certain allergens, including pet dander, household dust, and pollen.

Rescue inhalers

Rescue inhalers contain bronchodilators, a class of medication that dilates or opens up airways to help ease the flow of air. The medication is delivered directly to the lungs through inhalation.

After taking your rescue inhaler, you should feel the results within a few minutes. It's important to keep a rescue inhaler on you at all times to help counteract the effects of a sudden asthma attack.

Preventer inhalers

Preventer inhalers are usually taken once or twice a day or as prescribed by your doctor. These inhalers deliver a small dose of steroids to the lungs to help prevent inflammation of your airways. The steroid can help reduce the severity and frequency of an asthma attack.

Follow your doctor’s instructions closely and continue taking the inhaler even if you aren’t experiencing asthma symptoms.

Biologics

Biologics are a series of injections that target asthma reactions on the molecular level. They interrupt the process within your body that causes inflammation in the airways.

Injections containing biologics are given by your doctor over several weeks and can improve the frequency and severity of your asthma symptoms over time.

Bronchial thermoplasty

Bronchial thermoplasty uses heat to reduce the amount of muscle in your airways. This tissue is what becomes inflamed and swollen during an asthma attack, causing restricted breathing. Removing some of that tissue can help open up your airways and allow better airflow in and out of the lungs.

Recent studies⁴ have shown that bronchial thermoplasty can reduce asthma attacks and improve quality of life for five years or more. This minimally invasive procedure takes about an hour, with results in about a week.

If you have moderate persistent asthma, it's unlikely that you'll need bronchial thermoplasty. This is a treatment option most often recommended for people with severe persistent asthma who are not responding well to other treatment options, such as medication.

Can moderate persistent asthma be prevented?

There is no way to prevent the development of asthma, especially if you are genetically predisposed to the condition. However, early detection and diagnosis can lead to better outcomes and can help stop the decline in lung function.

You can also help prevent asthma symptoms from having a big impact on your life. Sticking to your treatment plan as prescribed by your doctor is key. You should continue to take any recommended medications even if your asthma symptoms seem to disappear. It's also important to identify and avoid your asthma triggers as much as possible. This can help reduce the severity and frequency of your asthma attacks.

With good management and care, you can keep your asthma symptoms under control and live a healthy, active life.

The lowdown

People with moderate persistent asthma experience daily symptoms, including coughing, wheezing, shortness of breath, or tightness in the chest. These symptoms may interfere with daily activities and disrupt sleep at least once a week.

People with moderate persistent asthma have decreased lung function, but with treatment, lung function and symptoms can improve. Treatment may include medications, lifestyle changes, or surgery. While there is no cure for this chronic inflammatory condition, it's possible to prevent the symptoms and live an active, healthy life.