Condition content was medically reviewed by an AllerVie Health physician in May 2023.
Severe asthma symptoms
Severe asthma symptoms are the same as the symptoms for regular asthma. The difference is that severe asthma symptoms do not respond to high doses of asthma treatments.
- Chronic cough
- Shortness of breath
- Chest tightness
- Neck and chest muscle straining
- Rapid breathing
- Changes in heart rate
Symptoms of a severe asthma attack
Severe asthma attacks can be life-threatening. Symptoms of severe asthma attacks in children and adults typically include:
- Rapid heartbeat
- Agitation/feeling of uneasy
- Shortness of breath and wheezing
- Shortness of breath without exertion/while resting
- Drowsiness or signs of confusion
- Symptoms that don't improve even after inhaler use
When to see a doctor about severe asthma
If your asthma symptoms are not controlled with your medications or inhaler, you should see your allergy specialist as soon as possible. People close to you should know that you suffer from asthma, be attuned to the symptoms of a severe asthma attack, and be ready to call for emergency treatment.
Measuring asthma with asthma severity chart
Asthma severity is measured by the presence and frequency of impairments that include:
- Asthma symptoms
- Nighttime awakenings
- SABA use – short acting beta antagonists used to control symptoms
- Interference with normal activity
- Lung function
These impairments are each ranked by severity to describe asthma as intermittent, mild, moderate or severe. These rankings are further broken down by age; 0-4 years, 5-11 years, and 12 years old and older.
Your allergy specialist will classify how severe your asthma is as a first step to developing a personalized treatment plan. You can help by keeping a detailed record of your symptoms, noting the symptom, when it started and how long it lasted.
Severe asthma triggers
Asthma is typically triggered by the following:
- Air pollution
- Weather changes
- Extreme emotional expressions
Severe asthma can become worse with the following:
- Bacterial infection
- Respiratory infection
- Respiratory virus
- Flu virus
Types of severe asthma
Allergic asthma is seasonal and the symptoms are the same as chronic asthma but it occurs only at certain times, or seasons, of the year.
Eosinophilic asthma (e-asthma)
Eosinophilic asthma is a type of severe asthma that usually starts in adulthood. It is caused by high levels of white blood cells called eosinophils in the airways of the lungs. These immune cells are over-reactive and cause swelling in the airways which can lead to asthma symptoms.
Non-eosinophilic asthma is the same as eosinophilic asthma except that it is not caused by high levels of white blood cells called eosinophils in the airways of the lungs.
Neutrophilic asthma is a type of non-eosinophilic asthma where there is a high level of neutrophils in the saliva and mucus in the respiratory tract that is typically there to fight off infection. It is associated with chronic bacterial or viral infections, obesity, smoking and airway smooth abnormalities.
Risk factors of severe asthma
The likelihood of developing severe asthma as an adult increases for:
Individuals with respiratory disease
Diagnosing severe asthma
Severe asthma is asthma that cannot be controlled by high-dose treatment with inhaled corticosteroids and additional oral asthma medication.
Your specialist will first rule out any existing diseases that should be treated and identify any triggers that should be eliminated.
It is also important to understand whether the symptoms actually indicate severe asthma or are the result of uncontrolled asthma.
Diagnosing severe asthma can include:
What is uncontrolled asthma?
Uncontrolled asthma is defined by the frequency of symptoms:
- Daytime asthma symptoms more than 2 times/week
- Waking at night with asthma symptoms more than 2 times/month
- Using quick-relief medicine more than 2 times/week
- Limiting activity because of asthma symptoms.
Severe asthma treatment
Many patients with asthma can control their symptoms by avoiding triggers, taking daily asthma medications and using a quick-relief inhaler. For patients with severe asthma additional treatments are often necessary.
Severe asthma medication
- Oral corticosteroids
Biologics to treat severe asthma
Biologics target a specific antibody, molecule, or cell involved in asthma. They disrupt the pathways that lead to inflammation that causes asthma symptoms. AllerVie offers biologics that target each type of severe asthma:
- Allergic asthma
- Eosinophilic asthma (e-asthma)
- Non-eosinophilic asthma
- Neutrophilic asthma
Patients with severe asthma may benefit from immunotherapy.
Outpatient procedure – bronchial thermoplasty
Bronchial thermoplasty uses heat to shrink the smooth muscles in the lungs. Patients report an improved quality of life after the procedure, reduced asthma symptoms and decreased emergency-room visits due to asthma attacks. Our AllerVie specialists perform this procedure on an outpatient basis.
Behavior and lifestyle changes
- Adopting a healthy diet rich in fruits, vegetables, whole grains and lean protein will help reduce inflammation
- Avoiding environmental triggers such as allergens and pollution
- Managing stress which can exacerbate asthma symptoms
- Smoking, obesity, GERD, exposure to environmental triggers are linked to Non-Type-2 inflammation
- Quitting smoking, changing diet, exercising, reducing exposure to environmental triggers
Management & prevention of severe asthma
The first step in managing severe asthma is to follow the asthma management plan your specialist provided. This plan is tailored specifically to you and your body. It is also important that you take an active role in managing your asthma:
- Take your medications as prescribed and keep your relief-inhaler with you at all times.
- Avoid triggers
- Monitor and record your symptoms
- Work with your specialist to ensure your asthma is controlled and your treatment plan is working
Frequently asked questions
Can severe asthma go away?
Asthma is not a disease for which there is a cure. It can, however, be controlled and people with asthma are not limited by the condition
Can an asthma attack last several days?
Yes, a severe asthma attack can last from hours to days.
Is severe asthma a disability?
Yes, asthma is considered a disability under the Americans with Disabilities Act (ADA).