2026 guideline-informed asthma tool

Asthma Control Assessment

Q: How do you assess whether asthma is controlled?

Review symptoms over the previous four weeks, including daytime frequency, night waking, activity limitation, and SABA reliever frequency when applicable. Assess future exacerbation risk separately.

Q: What counts as SABA overuse?

Use of three or more 200-dose SABA canisters per year is an exacerbation risk factor. Very high use of at least one canister per month is associated with asthma-death risk.

Assess asthma symptom control over the past four weeks and review future exacerbation risk factors—without confusing current control with treatment-defined asthma severity.

Symptom control Future-risk review Source-linked guidance

Educational decision support only. This review is for people age 6 years and older with an established or suspected asthma history. It does not diagnose asthma, direct medication changes, or assess an active emergency.

Ages 6 years and older

Assess control and future risk separately

Answer the symptom questions for the previous 4 weeks, then select every future-risk factor known to apply. This is an educational review—not a diagnostic test or treatment prescription.

Step 1

Recent symptom control

Symptoms on more than 2 days per week

Wheeze, cough, chest tightness, or shortness of breath during the past 4 weeks.

Any asthma-related night waking

Count any waking caused by asthma symptoms during the past 4 weeks.

Any activity limitation from asthma

Includes exercise, work, school, play, or usual daily activities.

Current reliever strategy

Step 2

Future-risk review

Select known factors. Unselected items are not counted and should not be assumed absent.

Severe exacerbation during the past 12 monthsFor example, an attack requiring systemic corticosteroids, emergency care, or hospitalization.Previous ICU admission or intubation for asthmaA lifetime history is clinically important even when current symptoms seem controlled.No ICS-containing treatment when indicatedAlso select for known under-treatment or an interrupted controller plan.Poor adherence or incorrect inhaler techniqueIncludes access, affordability, device-use, or treatment-barrier concerns.Smoking, vaping, pollution, or relevant allergen exposureInclude occupational or home exposure when it is clinically relevant.Relevant comorbidity or pregnancyExamples include obesity, chronic rhinosinusitis, symptomatic GERD, confirmed food allergy, or pregnancy.Major psychological or socioeconomic barrierIncludes barriers that interfere with access, adherence, follow-up, or self-management.Elevated eosinophils or FeNOInterpret biomarkers in context; they are affected by age, smoking, treatment, timing, and other conditions.Large bronchodilator response on lung-function testingA marked response can signal additional exacerbation risk even when baseline symptoms are limited.

SABA canisters in the past yearUse 200-dose canister equivalents when known.FEV₁ percent predictedOptional. Enter the most relevant recent value.

Complete the symptom questions and reliever selection to generate the review.

Built by a Registered Respiratory Therapist

Independent educational implementation

Evidence checked August 15, 2026

Correct clinical frame

Asthma control is not the same as asthma severity

Control describes how asthma is affecting the patient now and the likelihood of future adverse outcomes while receiving the current treatment. Severity is assessed retrospectively, after treatment has been optimized, from the intensity needed to control symptoms and prevent exacerbations.

This distinction matters because infrequent symptoms do not guarantee low risk. A patient may appear symptomatically well controlled and still have a concerning history, low lung function, medication overuse, or inadequate anti-inflammatory treatment.

Well controlled

No applicable symptom-control indicators

1–2

Partly controlled

One or two applicable indicators

3–4

Uncontrolled

Three or four applicable indicators

When the reliever is ICS-formoterol or another anti-inflammatory reliever, the SABA-frequency item is not applied. Average anti-inflammatory reliever use still belongs in the clinical review, but it should not be forced into a SABA-derived score.

Future exacerbation risk

Risk factors matter even when symptoms are quiet

Current guidance does not combine these findings into a universally validated numeric probability. PulmTools therefore reports an inventory of identified factors and highlights high-priority history rather than inventing a risk percentage.

Previous events

Severe exacerbation during the previous year
Lifetime ICU admission or intubation for asthma

Medication and technique

SABA overuse
No or inadequate ICS treatment
Poor adherence
Incorrect inhaler technique

Physiology and inflammation

FEV₁ below 60% predicted
Large bronchodilator response
Elevated blood eosinophils or FeNO

Exposures and context

Smoking, vaping, allergens, or pollution
Relevant comorbidities or pregnancy
Psychological or socioeconomic barriers

High-yield thresholds: three or more 200-dose SABA canisters per year signals increased exacerbation risk; extremely high use of at least one canister per month is associated with asthma-death risk. FEV₁ below 60% predicted is another important risk marker.

What to check before stepping up treatment

Confirm the asthma diagnosis and objective variable airflow limitation when possible.
Watch the patient use the inhaler and correct device-specific errors.
Review adherence, affordability, access, and treatment preferences without blame.
Address smoking, vaping, occupational exposure, allergens, and relevant comorbidities.
Document lung function and ensure the patient has a written asthma action plan.

Where FeNO fits

FeNO may support diagnosis or help guide treatment in selected patients, but it should not be used alone to determine control, predict an exacerbation, or grade exacerbation severity. Interpret FeNO alongside symptoms, lung function, treatment exposure, adherence, and phenotype.

Review NHLBI guidance

Common questions

Asthma control assessment FAQ

How do you assess whether asthma is controlled?

Recent symptom control is assessed over the previous four weeks using daytime symptom frequency, night waking, activity limitation, and—when a SABA reliever is used—reliever frequency. Future exacerbation risk should be assessed separately.

Is asthma control the same as asthma severity?

No. Control describes current symptom burden and future risk on the present treatment. Severity is assessed retrospectively from the treatment intensity required to control symptoms and prevent exacerbations.

Can well-controlled asthma still carry exacerbation risk?

Yes. Previous severe exacerbations, SABA overuse, inadequate inhaled corticosteroid treatment, low lung function, smoking, poor adherence, and other factors can increase future risk even when recent symptoms are limited.

What counts as SABA overuse?

Current GINA guidance identifies use of three or more 200-dose SABA canisters per year as an exacerbation risk factor. Very high use, such as at least one canister per month, is associated with asthma-death risk.

Does this tool diagnose asthma or recommend medication changes?

No. Asthma diagnosis requires a compatible history plus objective evidence of variable expiratory airflow whenever possible. This tool does not prescribe treatment or replace an individualized asthma action plan.

Why is ICS-formoterol reliever use handled differently from SABA use?

Current guidance does not score frequency of an anti-inflammatory reliever such as ICS-formoterol using the same more-than-twice-weekly symptom-control criterion used for SABA. Its average use should still be reviewed clinically.

Clinical references and methodology

Clinical logic was reviewed August 15, 2026 against the current international asthma strategy and current U.S. federal guidance. PulmTools paraphrases the underlying clinical concepts and does not reproduce a branded questionnaire.