What Is Severe Asthma?

man having a hard time breathing
Geber86/iStockphoto
In This Article
Table of Contents

With asthma, you can expect to suffer from ongoing airway inflammation and regular asthma flare-up. However, 5% to 10% of those with asthma are at a greater risk for flare-ups and are unable to manage symptoms with medication. They have a condition known as severe asthma. Severe asthma is a subtype of asthma that can affect people of all ages.

Previously known as status asthmaticus, severe asthma is defined as asthma that meets one of two criteria:

  • Requires medium or high-dose inhaled corticosteroids combined with other longer-acting medications
  • Cannot be controlled despite the proper use of the required medications

Sometimes called severe persistent asthma, this is a very serious condition that can greatly reduce your quality of life and may lead to other health problems if it's not properly addressed.

Symptoms

Like "regular" asthma, those with severe asthma suffer from wheezing, chest tightness, shortness of breath, and a chronic cough. In addition, severe asthma includes more serious problems.

These symptoms include:

  • Breathing difficulties that occur throughout the day
  • Frequent nighttime episodes
  • Dependence on rescue medication several times per day
  • Reduced lung function that impedes everyday activities

In rare cases, severe asthma can also lead to fatality.

Uncontrolled Symptoms Versus Uncontrolled Asthma

While severe asthma is an asthma classification referring to a condition in which symptoms cannot be controlled with medication, "uncontrolled asthma" is a different designation. Uncontrolled asthma refers to mild or moderate asthma in which symptoms are not well-managed with your current medication plan.

With uncontrolled asthma, you may suffer typical symptoms as well as nighttime flare-ups, and you may need to use your rescue inhaler several times a week or even daily. However, uncontrolled asthma should improve with treatment changes. When it doesn't you may be diagnosed with severe asthma.

Causes

Severe asthma may be caused by hypersensitivity to certain triggers such as pollen, dust mites, animal dander, mold, perfumes, and air pollution. Susceptibility to exercise-induced asthma is also likely to make it more difficult for you to manage asthma symptoms with an active lifestyle.

Demographic factors also impact your likelihood of suffering from severe asthma. Researchers have found that adults with asthma develop severe asthma as they age. Women and those who are obese are also at greater risk for the condition.

Pre-existing health issues can raise your risk of severe asthma. Medical problems related to the pulmonary and digestive tract can have a significant impact.

Chronic Sinusitis

Chronic sinus inflammation has been directly linked to asthma. This includes those with frequent sinus infections and those with perennial allergic rhinitis. In one study, about 33% of those with moderate or severe persistent rhinitis were also diagnosed with asthma. The more serious the inflammation, the greater the severity of asthma.

Gastroesophageal Reflux Disease (GERD)

GERD is a chronic disorder of the digestive system in which the esophageal doesn't completely close, so stomach acid comes back up the digestive tract. GERD has been associated with uncontrolled asthma because those acids from the stomach can be inhaled into the lungs and lead to increased asthma symptoms. If your asthma symptoms are not being well managed, your doctor may recommend trying GERD medications.

Other Diseases

Less common diseases to be considered when a person has uncontrolled asthma include:

  • Allergic bronchopulmonary aspergillosis: This fungal infection of the lung is caused by hypersensitivity to antigens that colonize the airways.
  • Churg-Strauss syndrome: A rare autoimmune condition, Churg-Strauss syndrome causes inflammation of the blood vessels and primarily affects the lungs.
  • Primary immunodeficiencies: These deficiencies of the immune system include a wide range of disorders. In adult asthmatics, the disorders frequently exacerbate asthma symptoms.

Sometimes, asthma symptoms aren't caused by asthma at all, which is why asthma medications don’t work. Vocal cord dysfunction (VCD) is a medical condition that mimics asthma but is caused by the vocal cords closing over the airway, leading to shortness of breath and wheezing-like sounds.

Your doctor should consider a VCD diagnosis if you are suffering from uncontrollable asthma symptoms. This diagnosis is best made using nasal endoscopy.

Diagnosis

A diagnosis of severe asthma is usually made if uncontrolled asthma does not improve with a change of medication. Your doctor may also check your overall pulmonary function since severe asthma often reduces lung function. Poor lung function can be determined by spirometry or a pulmonary function test (PFT). These breathing tests generally focus on your forced expiratory volume (FEV), or how much air you can exhale into a spirometer in one second.

Treatment

To be properly treated for severe asthma, you may need to consult with several specialists, including a pulmonologist, otolaryngologist (ear, nose, throat doctor), and an allergist.

A combination of treatments is often used to manage severe asthma. These may include:

  • Corticosteroids: Inhaled corticosteroids (ICS) are a first-line treatment to reduce inflammation and symptoms. Severe asthma often requires courses of stronger oral corticosteroids.
  • Beta-2 (β2) agonists: Both short-acting (SABAs) and long-acting (LABAs) β2 agonists may be used to help relieve bronchial muscle spasms. LABAs are more likely used in conjunction with an ICS to control more severe symptoms.
  • Anticholinergics: These medications relax the airway muscles to counter bronchoconstriction and enable you to breathe more easily.
  • Biologics: These are medications made from living organisms. To treat severe asthma, they target specific cells or chemical messengers to reduce inflammation and the overactive immune system responses that trigger asthma.
  • Immunotherapy: These "allergy shots" can reduce sensitivity to allergens, which can then reduce severe asthma symptoms in many people.

Coping

Severe asthma can significantly impact your quality of life. The chronic breathing issues may make it hard to work and enjoy leisure activities. Those with severe asthma are at greater risk of hospitalization compared to those with mild or moderate asthma.

It's important, therefore, to work closely with your doctor to ensure you are appropriately following the treatment plan. You should also consider consulting with a therapist to avoid depression, which is a common issue severe asthmatics face.

A Word From Verywell

Severe persistent asthma is more than having an occasional bad asthma attack or occasional episodes of uncontrolled symptoms. The condition can be dangerous and, possibly, fatal. To manage the condition, you need to enlist a team. Work with all your doctors and ensure any specialist you see is aware of the medication and advice offered by other doctors. You should consider maintaining your own medical file so you can share information with the doctors in case they don't receive updated records electronically. Taking control of your treatment in this way can help you take control of your asthma and allow you to enjoy a better quality of life.

Was this page helpful?
Article Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. American Lung Association. Severe Asthma. Updated May 13, 2020.

  2. American Academy of Allergy, Asthma & Immunology. Severe Asthma. Updated 2020.

  3. Teague WG, Phillips BR, Fahy JV, et al. Baseline Features of the Severe Asthma Research Program (SARP III) Cohort: Differences with AgeJ Allergy Clin Immunol Pract. 2018;6(2):545–554.e4. doi:10.1016/j.jaip.2017.05.032

  4. American College of Allergy, Asthma & Immunology. Sinus Infection. Updated 2014.

  5. Egan M, Bunyavanich S. Allergic rhinitis: the "Ghost Diagnosis" in patients with asthma. Asthma Res Pract. 2015;1:8. doi:10.1186/s40733-015-0008-0

  6. Shah SGS. A Commentary on "Ensuring safe surgical care across resource settings via surgical outcomes data & quality improvement initiatives." Int J Surg. 2019;72:14-15. doi:10.3109/02770903.2012.662568

  7. Churg Strauss Syndrome. National Organization for Rare Disorders (NORD). Updated 2020.

  8. Lee SH, Ban GY, Kim SC, et al. Association between primary immunodeficiency and asthma exacerbation in adult asthmatics. Korean J Intern Med. 2020;35(2):449-456. doi:10.3904%2Fkjim.2018.413

  9. Barisione G, Baroffio M, Crimi E, Brusasco V. Beta-Adrenergic Agonists. Pharmaceuticals (Basel). 2010;3(4):1016-1044. do:10.3390%2Fph3041016