Severe Asthma: Definition, Symptoms and Treatment

Discover the facts about severe asthma, its symptoms and how it differs from other types of asthma and the treatment options available.

What is severe asthma?

Severe asthma is a type of asthma that does not respond well to standard asthma treatments. The symptoms of severe asthma, by definition, are more intense than regular asthmatic symptoms and can last for prolonged periods. Sufferers of severe asthma often find their symptoms persistent and difficult to control.

Having severe asthma can have a major impact on daily life, affecting everyday habits, work and social life.It can affect both children and adults, and can develop at any age. However, it’s a lot less common than a standard asthma diagnosis, affecting less than 10% of people.

Although severe asthma can be difficult to cope with, and it can take time to find the right treatment combination, it can be effectively managed. It’s important that you look after yourself carefully by taking your medication exactly as prescribed, having regular asthma reviews, understanding your asthma triggers and communicating with your healthcare team, so they know when and how to adjust your medication regime.

What’s the difference between severe asthma and chronic asthma?

All types of asthma, no matter whether it is mild, moderate or severe, are chronic, long term conditions. Severe chronic asthma is categorized by the fact that it does not respond well to typical asthma treatments and medications.

What is severe bronchial asthma?

Severe bronchial asthma is another term for severe asthma. Both terms refer to the chronic inflammatory disease of the airways that is typically characterized by bronchial hyperreactivity.

Symptoms of severe asthma

The symptoms of severe asthma include:

  • Coughing
  • Wheezing
  • Difficulty breathing
  • Shortness of breath
  • Chest tightness
  • Chest pain
  • Asthma attacks.

The symptoms of severe asthma can be unpredictable and occur during the day and night. They can affect people’s everyday lives and the ability to carry out normal tasks. If severe asthma symptoms aren’t controlled effectively, they can be very debilitating.

Symptoms of a severe asthma attack

If you suddenly experience a severe asthma attack, then you may experience one or more of the following symptoms:

  • A bluish tint to your lips, face or fingernails
  • Feeling that you need to stand up or sit in order to try and breathe more easily
  • Feeling confused or agitated
  • Being unable to speak in full sentences
  • Feeling very short of breath and unable to inhale or exhale fully
  • Rapid breathing
  • Symptoms that don’t get better after using a reliever inhaler.

With a very severe asthma attack, the usual symptoms of wheezing or coughing might not worsen. This is because your airways may be so affected that you can’t get enough air in or out of your lungs to cause wheezing sounds or make you cough.

A severe asthma attack is a medical emergency and you should go to a hospital immediately. Compared to mild asthma attacks that may only last a few minutes, severe asthma attacks can last from hours to days and may be life-threatening if left untreated.

Assessment tools

Asthma severity assessment tool

Airway remodelling

One potential long-term effect of severe asthma, and particularly poorly controlled severe asthma, is a condition called airway remodelling.

If you’ve had frequent bad asthma attacks or lots of asthma symptoms that you’ve been unable to control, your airways will get thicker, more inflamed and scarred over time. This means the airway becomes narrower – making it harder to breathe, which in turn makes your symptoms worse.

This is one of the reasons why it’s important to manage your asthma effectively, no matter how laborious it can seem with severe asthma. With good management, you can reduce the risk of airway remodelling occurring.

Treatment of severe asthma

There is no single treatment or medication solution for severe asthma. Everyone is affected differently and what works well for one person may have no effect on another. The same medications may be prescribed as someone who has a milder asthma, but at a much higher dose.

Treatment of severe asthma focuses on trying to control the symptoms. You’ll be prescribed medication and treatment to manage the inflammation in your airways and prevent lung damage. You’ll also be advised to reduce the risk of coming into contact with asthma triggers as much as possible, as this will reduce your risk of having a severe asthma attack.

As a starting point, everyone with asthma is prescribed:

  • A reliever inhaler – usually blue, this inhaler is used to provide relief when you need it and should be carried with you at all times.
  • A preventer inhaler – often brown, contains corticosteroids that help to reduce swelling and inflammation in the airways. This needs to be taken every day, as prescribed by your doctor.

If you’re diagnosed with severe asthma, you should speak to your doctor about a referral to a specialist clinic. While some primary care surgeries have dedicated asthma nurses that can offer specialist support.

Additional medication for severe asthma

In addition to a reliever and preventer inhaler, severe asthmatics may be prescribed other treatments. You may need to try several options before your healthcare provider finds the right choice for your needs.

In addition to inhalers, treatment options for severe asthma include:

  • Long-acting bronchodilators (LBAs) – these can be added to a preventer inhaler and help keep the airways open for at least 12 hours.
  • Leukotriene receptor antagonists (LTRAs) – a non-steroid tablet that helps to calm inflamed airways, block the effects of leukotrienes (inflammatory molecules) and help with allergies.
  • Long-acting muscarinic receptor antagonists (LAMAs) – a form of long-acting bronchodilator that can work for 12-24 hours.
  • Long-acting beta-agonists (LABAs) – another form of long-acting bronchodilator that is used to relax the muscles in the airways.
  • Slow-release theophylline – a non-steroid tablet that helps to relax the smooth muscles in the airways, enabling air to more easily flow through.
  • Short-acting beta 2-agonists – a form of quick relief medication that can be used when asthma symptoms occur.
  • Daily steroids – these are prescribed in tablet or liquid form and are a type of anti-inflammatory medicine. They work by helping to reduce the sensitivity in the airways.
  • Monoclonal antibodies (also called mAbs or biologics) – a newer form of medication for severe uncontrolled asthma. They work by blocking the activity of immune system chemicals that trigger airway inflammation.

In some cases, bronchial thermoplasty might be recommended. This is form of surgical procedure where a flexible tube is passed down into the airways in the lungs to deliver a specialist form of heat treatment. It’s usually a day treatment with a local anaesthetic, but it may involve the need for several sessions.

You should also get a flu vaccination each year at the start of the flu season. Flu affects the respiratory system and can last up to two weeks, meaning that it can be life threatening for someone with severe asthma. It is important to opt for the shot, not a nasal spray, which may trigger your asthma symptoms.

Lifestyle changes to help severe asthma

As well as medication, there are lifestyle changes you can make that can help.

  • Maintain a healthy weight and exercise routine. If you’re taking long-term high doses of oral corticosteroids, they can increase appetite and cause weight gain. It can be difficult to manage your weight with severe asthma, as your symptoms may make exercise more difficult, and you may lack energy and motivation if you’re feeling unwell. But even by making small changes to your diet and activity levels, you can make a difference.
  • Quit smoking. Smoking is a major risk factor for asthma attacks, as well as being associated with numerous other health problems. If you smoke and have asthma, you should try to quit. Seek help from your doctor, nurse or a smoking cessation group to help make the change.
  • Do breathing exercises. Regularly practising breathing exercises can be beneficial as they help to improve lung capacity, strength and health. There are various methods suitable for asthmatics, some of which are taught by experts or physiotherapists, and they’re easy to learn and practice at home.
  • Reduce your stress levels. To reduce stress – which can be a key trigger for asthma – incorporating yoga, meditation or mindfulness practice into your lifestyle may be helpful.

Before making any lifestyle changes, it’s a good idea to discuss this with your doctor or asthma nurse first. This will allow them to signpost additional support and advise any modifications to meet your specific needs. Your friends, family and employer can also act as advocates, helping you to make adjustments to your home and work life.

Useful treatment tools

Prevention and management of severe asthma

Alongside taking your medication as prescribed, the best way to reduce the risk of severe asthma attacks and worsening symptoms is to avoid triggers as much as possible.

As part of your asthma management plan, it’s important to monitor your severe asthma symptoms. It’s useful to keep a written record of your symptoms, when they occur and any triggers that may be involved. For example, your symptoms might be triggered by environmental factors, such as seasonal pollen. For women, a change in hormone levels may make things worse.

By spotting patterns you can learn to take action before symptoms worsen. A record can also act as a form of encouragement, highlighting how things have improved over time. It’s also  really useful to be able to show your asthma nurse or doctor at appointments.

Further information: webinars and learning modules

Sourced from GAAPP Member Organization Allergy and Asthma Network.