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Severe Asthma
Severe asthma affects only 5 to 10% of people with asthma. Severe asthma is difficult to control with standard asthma treatments, but can still be managed with the help of an allergy specialist.
Make An AppointmentCondition content was medically reviewed by an AllerVie Health physician in May 2023.
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:
- Allergic asthma
- 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.
- 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.
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:
Men
Smokers
Individuals with respiratory disease
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:
- A complete medical history
- Clinical examination
- Lung function testing
- Allergy testing
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.
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Severe asthma medication
- Antibiotics
- Oral corticosteroids
02
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
03
Immunotherapy
Patients with severe asthma may benefit from immunotherapy.
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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.
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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