Asthma is a chronic lung disease that causes inflammation and narrowing of the airways, making breathing difficult. Asthma symptoms can range from mild to very severe. Knowing whether your asthma is severe is important, as severe asthma requires more aggressive treatment to keep it under control.
What are the symptoms of severe asthma?
Severe asthma symptoms include:
- Frequent asthma attacks requiring urgent care visits or hospitalizations
- Asthma symptoms throughout the day, at night, and with physical activity
- Little or no symptom relief from using a rescue inhaler
- Decreased lung function shown on pulmonary function tests
- Side effects from oral corticosteroids used to control symptoms
If you have asthma but are not experiencing these persistent and severe symptoms, your asthma would likely be classified as mild or moderate.
What causes severe asthma?
Severe asthma is thought to be caused by multiple factors, including:
- Genetics – Family history of asthma or allergies
- Environmental exposures – Allergens, tobacco smoke, air pollution
- Respiratory infections
- Obesity
- Stress and anxiety
- Gastroesophageal reflux disease (GERD)
These factors likely trigger increased airway inflammation that is more resistant to treatment in people with severe asthma.
How is severe asthma diagnosed?
To diagnose severe asthma, your doctor will:
- Review your medical history, including symptoms, triggers, family history, missed school/work days
- Perform a physical exam of your lungs
- Order lung function tests, including spirometry and peak flow monitoring
- Consider allergy testing and chest x-rays to rule out other lung diseases
- Assess your adherence to prescribed asthma medications
Based on these assessments, your doctor can determine if your symptoms, rescue inhaler use, and lung function indicate severe asthma.
How is severe asthma treated?
Treatment for severe asthma aims to:
- Prevent symptoms and attacks
- Reduce airway inflammation
- Improve lung function
- Decrease the need for rescue inhalers
Treatment options may include:
- Inhaled corticosteroids – High dose preventive inhalers to reduce inflammation
- Long-acting beta agonists – Inhalers to open airways for up to 12 hours
- Leukotriene modifiers – Oral medication to block leukotrienes that cause inflammation
- Biologic therapies – Injectable antibodies that target specific proteins involved in inflammation
- Oral corticosteroids – Used short-term for severe symptoms and attacks
- Allergen immunotherapy – Gradual exposure to allergens to desensitize your immune system
- Bronchial thermoplasty – Heat treatment to reduce excess smooth muscle in airways
Following your prescribed treatment plan, avoiding triggers, and monitoring your symptoms daily helps gain control over severe asthma.
What happens if my severe asthma is uncontrolled?
Uncontrolled, severe asthma can:
- Cause frequent exacerbations requiring oral corticosteroids
- Lead to emergency room visits or hospitalization
- Interfere with work, school, or daily activities
- Permanently decrease lung function over time
- Negatively impact your quality of life
That’s why it’s critical to work with your doctor to find the right medications and treatment plan to get your severe asthma under control.
When should I see a specialist for severe asthma?
You should see an asthma specialist, like an allergist or pulmonologist, if you have:
- Frequent exacerbations requiring oral steroids
- Two or more hospitalizations for asthma in the past year
- The need for daily oral steroids to control your asthma
- Reduced lung function that persists even when your asthma feels controlled
- Concerns about medication side effects
A specialist can help identify your specific asthma triggers, adjust your medications, and develop an individualized treatment plan for your severe asthma.
What is an asthma action plan?
An asthma action plan outlines:
- Your daily treatment regimen
- How to recognize worsening asthma symptoms
- What extra medications to take if your symptoms flare up
- When to seek emergency care
Having a written action plan helps you manage your severe asthma on a daily basis and know what to do when symptoms get out of control. Your doctor can work with you to create a personalized plan.
What lifestyle changes can help severe asthma?
Making certain lifestyle changes may help improve severe asthma symptoms:
- Quit smoking and avoid secondhand smoke
- Limit exposure to air pollution when possible
- Use allergen-proof bedding covers to reduce dust mites
- Consider having pets live outside the home if allergic
- Exercise indoors when air quality is poor
- Lose weight if overweight or obese
- Manage stress, anxiety, and depression
- Eat a balanced, nutritious diet high in antioxidants
Avoiding triggers is key, but always carry your rescue inhaler in case of an asthma flare up.
How can I reduce asthma flare ups from colds and flu?
- Get an annual flu vaccine
- Wash hands frequently to reduce spread of viruses
- Avoid close contact with those who are sick
- Consider wearing a mask in crowded indoor spaces during peak cold and flu season
- Talk to your doctor about temporary increase in asthma meds when ill
Should I get a pneumonia vaccine?
Yes, adults and children over age 2 with asthma are recommended to get vaccinated against pneumonia, which can be life-threatening for those with lung disease. Talk to your doctor about getting the pneumococcal vaccines.
Conclusion
Severe asthma causes persistent symptoms that interfere with daily life. Key indicators include frequent exacerbations requiring oral corticosteroids, low lung function, and poor symptom control despite prescribed treatment. Seeing a specialist, following an action plan, avoiding triggers, and getting recommended vaccines helps manage severe asthma.
Work closely with your doctor and follow their prescribed treatment plan to gain control over your severe asthma symptoms.