Condition content was medically reviewed by an AllerVie Health physician in May 2023.

Kid with severe asthma using an asthma inhaler at the park

What is severe asthma?

Severe, persistent asthma does not respond to typical asthma treatments that include high doses of inhaled corticosteroids, controllers and oral corticosteroid treatment.

It is important that severe asthma is not confused with uncontrolled asthma. If your asthma management plan is being followed and your symptoms persist, you may have severe asthma. 

Severe asthma can be categorized into three types:

  1. Allergic asthma
  2. Eosinophilic asthma – a type of asthma that is caused by high levels of white blood cells called eosinophils in the airways of the lungs. When these immune cells are over-reactive they can cause inflammation in the body, including in the lungs.
  3. Non-eosinophilic asthma

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
  • Wheezing
  • 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. 

Little girl with severe asthma crying while getting in inhaler mask in hospital

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:

  • Allergens
  • Air pollution
  • Exercise
  • Weather changes
  • Foods
  • Additives
  • Drugs
  • Extreme emotional expressions

Severe asthma can become worse with the following:

  • Bacterial infection
  • Respiratory infection
  • Respiratory virus
  • Flu virus
  • Coronavirus

Types of severe asthma

Allergic asthma

Eosinophilic asthma (e-asthma)

Non-eosinophilic asthma

Neutrophilic asthma

Risk factors of severe asthma

The likelihood of developing severe asthma as an adult increases for:



Individuals with respiratory disease

Medical doctor applying medicine inhalation treatment on a little girl with severe asthma.

Complications of severe asthma

Living with severe asthma can be challenging. Complications can include:

  • Life-threatening asthma attacks
  • Complex treatment plans
  • Emotional and financial burdens
  • Limits to physical activity, employment, travel, relationships
  • Negative impacts on mental health

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

  • Antibiotics
  • 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

Learn more about Biologics for asthma



Patients with severe asthma may benefit from immunotherapy.

Learn more about 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
  • Exercising
  • 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?

Can an asthma attack last several days?

Is severe asthma a disability?