How Much Do You Know About Severe Asthma?

by Stephanie Stephens Health Writer

If you're one of more than 25 million people in the United States with asthma, your airways or bronchial tubes get inflamed, swollen and tight, making movement of air more difficult. You may cough, or wheeze, or have trouble breathing. With severe asthma, your asthma is more difficult to control — even with high-dose treatment — and causes more symptoms and attacks than other types of asthma. Here's what else you should know about severe asthma.

Asthma attack, reaching for inhaler.

How severe asthma affects you

It's estimated that between 5 and 10 percent of all asthma patients have severe asthma. Asthma can interfere with your ability to lead a normal life, affect how well you do in school or at work, and negatively impact fun and leisure time. You have frequent symptoms and you use rescue medications more often. You may even wake up at night and go to the emergency room frequently.

Waking up and in need of inhaler

Other types of asthma

Here's how severe asthma compares to other subtypes. Mild intermittent asthma symptoms occur less than twice weekly, and you wake up less than twice monthly. Mild persistent asthma symptoms occur more than two or three times weekly, and may limit daily activity. You wake up as many as four nights monthly. Moderate persistent asthma symptoms occur daily and you wake up at least one night a week.

Woman recovering in hospital after asthma attack.

Importance of preventing attacks

Severe asthma attacks are known as exacerbations. Maybe you experience coughing, wheezing, and trouble breathing, and your normal treatments just don't work. Your doctor may have recommended a steroid such as prednisone, and maybe that is also ineffective. That's when you need to visit the emergency room for help. It's important for you to prevent these attacks by using good self-management, because they can make you susceptible to even more attacks in the future.

Inflamed airways

Why you have severe asthma: Part 1

Chronic inflammation causes asthma. Even though your doctor has prescribed effective medications, your asthma may be a result of when chemicals in your body don't respond to your medications. Even though your doctor has prescribed effective medications, your asthma may be the result of inflammatory mediators or allergic reactions that do not respond to that medication. And if your airways are consistently inflamed, many medications simply won't be that effective.

Preparing blood sample

Why you have severe asthma: Part 2

Severe asthma can be caused by inflammation from white blood cells called eosinophils. To determine this, your doctor can perform a blood test to measure the eosinophil count in your blood. If that count is unusually high, you may be prescribed a different type of asthma treatment. Eosinophilic asthma may be present in more than 60 percent of people with severe asthma.

Asthma medications.

Treatments for severe asthma

According to the latest treatment information in UpToDate, most people with severe asthma use more than one medication, including short-acting beta agonists; controller therapy (oral or inhaled glucocorticoids; or long-acting beta agonists.

Traditional asthma medication.

When traditional treatments don't work

Patients with persistently uncontrolled asthma may be candidates for these injectable therapies: anti-immunoglobulin E (anti-IgE): omalizumab; or anti-interleukin-5 (anti-IL-5): mepolizumab or reslizumab. Bronchial thermoplasty uses heat applied to airways during bronchoscopy to reduce increased mass of airway smooth muscle.

Dust mites on pillow fibers.

Keeping tabs on triggers: Part 1

Be aware of triggers to your asthma, especially with severe asthma: dust mites; tobacco smoke; animal allergens such as pet dander; respiratory illness such as flu, colds or sinus infections; mold and mildew; outdoor allergens such as pollen or grass.

Air pollution over city.

Keeping tabs on triggers: Part 2

Additional triggers include outdoor air pollution; workplace irritants; exercise, especially in cold air; strong emotions such as anger, crying, fear or excitement; sulfites in food; hormones during a woman's menstrual cycle.

Doctor explaining asthma medication.

Team up with your doctor

Maintain open communication with your doctor who treats asthma, and share any changes in your symptoms. You want to control your severe asthma, because if not, your airways could be permanently scarred (airway remodeling). That makes severe asthma harder to treat. To control your weight, ask about exercise if severe asthma prevents you from working out at your peak. Ask about how to get sufficient sleep, and share if you're anxious or depressed. Better control means a more normal, happy life.

Stephanie Stephens
Meet Our Writer
Stephanie Stephens

Stephanie Stephens is a very experienced digital journalist, audio/video producer and host who covers health, healthcare and health policy, along with celebrities and their health, for a variety of publications, websites, networks, content agencies and other distinctive clients. Stephanie was accepted to THREAD AT YALE for summer 2018 to author and produce an investigative series. She is also active in the animal welfare community.