Asthma is an inflammatory lung disease that can range from occasional and mild to severe. Your asthma is considered severe if it’s unable to be well controlled with any type of treatment. It may also refer to asthma that can only be controlled by very high doses of inhaled corticosteroids or long-term, oral corticosteroids in addition to other daily medications.

In most cases, asthma can be controlled through daily medications and other treatment options.

Some doctors have differing opinions on what should be considered severe asthma. The World Health Organization puts severe asthma into three different categories.

The three categories of severe asthma are:

  • untreated asthma
  • difficult-to-treat asthma
  • therapy-resistant asthma

The symptoms of severe asthma are much like the symptoms of mild to moderate asthma. However, these symptoms tend to be more intense, potentially life-threatening, and can’t be easily controlled by asthma medications or treatments.

Signs and symptoms of severe asthma may include:

Severe asthma attack symptoms

The symptoms of a severe asthma attack may include:

  • severe shortness of breath where you experience difficulty speaking
  • rapid breathing with the chest or ribs visibly having retractions
  • straining your chest muscles and working hard to breathe
  • nostrils that flare out, moving rapidly as you breathe
  • face, lips, or fingernails becoming pale or blue in color
  • difficulty inhaling or exhaling fully
  • symptoms not getting better after using a rescue inhaler
  • inability to perform normal activities
  • infants may not recognize their parents or respond to them

If you or your child is having symptoms of a severe asthma attack, you should call 911 for immediate medical attention. Severe asthma attacks can lead to respiratory failure, which is a life-threatening condition.

The triggers of asthma, including severe asthma, vary for each person. Some triggers may include the following:

Some of the reasons you may have severe asthma that cannot be controlled include:


  • Eosinophilic asthma. Eosinophilic asthma is a type of asthma caused by increased levels of inflammation in the airway due to white blood cells called eosinophils.
  • Inflamed airways. Airways are inflamed to a level that medications can’t reduce the inflammation enough to clear your airway.
  • Environmental triggers. The cause of the airway inflammation is a chemical or other enviromental irritant that medications cannot easily control. This is often from occupational exposure.
  • Obesity. Obesity may cause your asthma to become severe and more difficult to treat.
  • Poor treatment adherence. Not adhering to the treatment your doctor prescribed to manage your asthma.


The definition of severe asthma is that it either doesn’t respond to treatments and medications at all, or it’s very difficult to treat. This lack of response to medications, known as therapy-resistant asthma, may be because your asthma has become resistant to corticosteroids or other medications used to treat asthma.

Other medications and treatments that you can try for severe asthma may include:

  • corticosteroid injections
  • higher doses of inhaled corticosteroids
  • using inhaled corticosteroids more frequently
  • continuous inhaled nebulizer
  • ipratropium bromide aerosols
  • long-acting beta-agonists (LABAs)
  • montelukast
  • theophylline
  • oral corticosteroids

The medications listed above may be used alone or in combination to try to get your severe asthma under control.

Lifestyle changes

The following lifestyle changes may help in the treatment of your severe asthma:

  • when possible, remove or avoid any allergens or exposure to environmental irritants like chemicals
  • gradually lose weight if you’re obese under the care of your doctor
  • avoid known triggers whenever possible
  • work with your doctor to find a treatment plan you can follow strictly
  • don’t smoke

Severe asthma usually requires lifelong treatment and medical management. Since severe asthma is difficult to treat, the length of recovery time from a severe asthma attack will vary based on your individual situation and the length of time it takes to get the severe asthma attack under control.

Severe asthma can sometimes lead to lung damage which may be permanent and may require additional treatment. That’s why it’s so important to get assistance as soon as possible during a severe asthma attack.

The best way to prevent severe asthma and severe asthma attacks is to follow the treatment plan that you were given by your doctor. If your current one isn’t working, work with them to adjust it.

Other ways you can prevent severe asthma and severe asthma attacks include:

  • track your symptoms and use medications regularly to manage them
  • if you smoke, get help quitting
  • get routine vaccinations for the flu, whooping cough, and pneumonia
  • let your doctor know if you notice your treatment plan and medications stop working
  • reduce your exposure to any allergens that may trigger your asthma
  • wear a mask on your face when you exercise in cold weather
  • take proper precautions when handling chemicals in your occupation
  • avoid going outside on days with poor air quality
  • talk to your doctor about a weight loss plan if you’re overweight
  • use your rescue inhaler as instructed at the first signs of an asthma attack
  • use daily medications as directed, which includes allergy treatments and other medications

Ask your doctor to help you create an asthma action plan. This action plan will outline the steps you need to take in case of an asthma attack. You should share this plan with your family or those that are around you often. By sharing your plan, they’ll be able to help you in case of an asthma attack.

Treatments and lifestyle changes for severe asthma must be consistently followed according to your doctor’s treatment plan for you. The goal of treatment is to get your asthma under control.

It’s important to discuss all treatment options with your doctor including all possible side effects. Many times, the benefits of medications and treatments will outweigh the side effects. However, it’s important that you understand any risks associated with your medications.

Remember, if you have a severe asthma attack, you should immediately call 911 and get prompt medical attention.