What is severe asthma?

Asthma is a disease that narrows your airways, making it hard to breath air out. This leads to air being trapped, increasing pressure inside your lungs. As a result, it becomes harder to breathe in.

Asthma can cause symptoms that include:

  • shortness of breath
  • wheezing — a whistling sound when you breathe
  • fast breathing
  • coughing

Everyone’s asthma is different. Some people have only mild symptoms. Others have more frequent attacks that are intense enough to land them in the hospital.

Treatments for asthma prevent attacks and treat them when they start. Yet about 5 to 10 percent of people with asthma won’t find relief, even when they take high doses of medication. Asthma that is uncontrollable on medication is considered severe.

Severe asthma is treatable, but it requires therapies and support that are different from those for mild or moderate asthma. It’s important to get treated, because severe asthma can lead to complications if you don’t address it.

Read on to learn when to see your doctor and find out what treatments are available for severe asthma.

What causes severe asthma?

If you’ve been taking your asthma medicine just like your doctor prescribed and you still have frequent attacks, you may have severe asthma. There are a few reasons why standard asthma treatments might not be enough to control your symptoms.

  • Your airways are so inflamed that current drugs aren’t strong enough to bring down the swelling.
  • The chemicals that trigger inflammation in your lungs don’t respond to any of the drugs you take.
  • A type of white blood cell called an eosinophil triggers your asthma. Many asthma medications don’t target eosinophilic asthma.

The severity of your asthma can change over time. You might start out with mild or moderate asthma, but it can eventually get worse.

When to get medical attention

You and your doctor should have an asthma action plan. This plan explains how to treat your asthma and what steps to follow when your symptoms flare up. Follow this plan whenever you have asthma attacks.

If your symptoms don’t improve with treatment or you’re having more frequent attacks, call your doctor.

Get immediate medical help if:

  • you can’t catch your breath
  • you’re too breathless to talk
  • your wheezing, coughing, and other symptoms are getting worse
  • you have low readings on your peak flow monitor
  • your symptoms don’t improve after using your rescue inhaler

Complications of severe asthma

Frequent, severe asthma attacks can change the structure of your lungs. This process is called airway remodeling. Your airways become thicker and narrower, making it harder to breathe even when you’re not having an asthma attack. Airway remodeling can also cause you to have more frequent asthma attacks.

Living with severe asthma for many years can also increase your risk for chronic obstructive pulmonary disease (COPD). This condition includes a cluster of lung conditions like emphysema and chronic bronchitis. People with COPD cough a lot, produce too much mucus, and have trouble breathing.

How to treat severe asthma

The main treatment for asthma is a daily long-term control medication like an inhaled corticosteroid, plus quick-relief (“rescue”) medicines like short-acting beta-agonists to stop asthma attacks when they happen. Your doctor will increase the dose as much as needed to control your symptoms. If your asthma still isn’t controlled with high doses of these medicines, the next step is to add another drug or therapy.

Biologic drugs are a newer type of asthma medicine that targets the cause of your symptoms. They work by blocking the activity of immune system chemicals that make your airways swell up. Taking a biologic can prevent you from getting asthma attacks and make the attacks you do have much milder.

Four biologic drugs are approved to treat severe asthma:

  • reslizumab (Cinqair)
  • mepolizumab (Nucala)
  • omalizumab (Xolair)
  • benralizumab (Fasenra)

Your doctor might also recommend one of these other add-on treatments for severe asthma:

  • Tiotropium (Spiriva) is used to treat COPD and help control asthma.
  • Leukotriene modifiers, like montelukast (Singulair) and zafirlukast (Accolate), block a chemical that narrows your airways during an asthma attack.
  • Steroid pills bring down inflammation in your airways.
  • Bronchial thermoplasty is a surgical procedure that opens up your airways.

Work with your doctor to find the right combination of medicines to manage your symptoms. You may go through periods when your asthma gets worse and periods when it improves. Stick with your treatment, and let your doctor know right away if it isn’t working so you can try something else.