Understanding Severe Asthma

Who's at risk and what can help you live better?

Man about to use asthma inhaler
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If you're diagnosed with severe asthma, the term may be confusing. Does having severe asthma mean that you have severe symptoms, or is a different type of asthma altogether?

Severe asthma actually is a very specific subtype of asthma. It is sometimes referred to as persistent severe asthma and is more defined than having occasional severe or uncontrolled symptoms.

Who Has Severe Asthma?

An estimated five percent of all individuals who have asthma meet the criteria for severe asthma. You may be more at risk if:

  • You have other health problems in addition to your asthma, such as diabetes and obesity. Psychological symptoms such as anxiety may also contribute to breathing problems.
  • If you are a smoker.
  • If you are not compliant with your asthma treatment. 

You may be diagnosed if your symptoms are not controlled with the use of certain medications like high dose inhaled glucocorticoids combined with systemic corticosteroids, long-acting beta agonists, or leukotriene modifiers. You may also be diagnosed if you required this treatment combination to keep your asthma controlled more than 50 percent of the previous year.

Pulmonary function tests may or may not play a role in diagnosing severe asthma. In general, people with severe asthma tend to have a forced expiratory volume less than 60 percent of predicted.

Symptoms

Severe asthma consists of extreme symptoms that are usually uncontrolled despite the use of specific medications. They include:

  • Difficulty breathing that continues throughout the day.
  • Waking up frequently during the night with symptoms.
  • Needing to use a rescue inhaler several times a day.
  • Breathing problems that limit your ability to participate in normal activities or even function.

    Coping with the effects of these symptoms is difficult—if you have severe asthma, you are more likely to be unable to hold down a job and are also more likely to spend time in the hospital. The high cost of treatment and loss of work can cause a strain on financial resources. Depression and feelings of frustration are also very common.

    However, there is help available. Individuals with significant community and family support tend to have better treatment outcomes than those who lack these important resources. Seeking therapy and other support groups, like those online, can make a big difference in mood and day-to-day coping as well.

    Treatment Options

    Severe asthma is best treated by a doctor who specializes and has experience in treating this condition. Multiple types of doctors may be necessary for treating all aspects of this complex illness. Your team may include a pulmonologist, otolaryngologist (ear, nose, throat doctor), and an immunologist/allergist.

    Conditions such as allergies, nasal polyps, or sinus problems may also contribute to your asthma symptoms. If you have severe asthma you should be evaluated and appropriately treated for these conditions. Allergies, in particular, can greatly exacerbate asthma symptoms and should be managed appropriately.

     Immunotherapy (allergy shots) for dust mites, pollen, or animal dander may be recommended.

    It is important that anyone with severe asthma adhere to their treatment regimen by taking all of their medications on time and as directed. You should also work with your doctor to develop a written treatment plan that helps you to recognize if your health is deteriorating or if you need immediate medical attention.

    You should receive instruction on the most effective way to use inhaled medications to ensure they are being used correctly. This may include instruction on the use of spacers and metered dose inhalers.

     Nebulizers may be necessary to best deliver inhaled medications.

    Triggers such as exercise or allergies must be identified and avoided. Also, obesity can make many breathing problems including asthma worse so weight management may be an appropriate part of your treatment.

    Non-medical treatment such as physiotherapy may be beneficial in conjunction with the treatment listed above. A physiotherapist may teach you different ways of breathing (breathing retraining), how to change your breathing patterns, relaxation techniques, or help you to modify your exercise routine so that you can still participate in physical activity despite your breathing problems. There is not enough evidence to recommend this as a stand-alone treatment, but some studies suggest it may improve symptoms and psychological well being.

    View Article Sources
    • Pollart, SM & Elward, KS. (2009). Overview of Changes to Asthma Guidelines: Diagnosis and Screening. Am Fam Physician. 79(9):761-767.
    • Severe Asthma. Asthma.net. Updated March 31, 2016. https://asthma.net/living/severe-asthma/
    • Thomas, M and Bruton, A. (2014). Breathing exercises for asthma. Breathe. 10: 312-322; DOI: 10.1183/20734735.008414