If you’re experiencing asthma symptoms regularly or your symptoms are getting worse despite treatment, you may need a more effective treatment method.

Severe asthma is often harder to control than mild to moderate asthma. It may require higher dosages and more frequent use of asthma medications. If you’re not managing it properly, severe asthma can be dangerous and even life threatening in some cases.

It’s important that you’re able to recognize when your condition isn’t properly managed. Doing so can help you take steps to find a more effective method of treatment.

Here are eight signs that your severe asthma is getting worse and what to do next.

1. You’re using your inhaler more than usual

If you’ve been having to use your quick-relief inhaler more often than usual, or you’ve started to feel like it doesn’t help as much when you do use it, your severe asthma may be getting worse.

It can be hard sometimes to keep track of exactly how many times you use your inhaler during a given week. If you suspect your usage is increasing, you may want to start keeping track in a journal or in a note-taking app on your phone.

Keeping a log of your inhaler usage can also help to identify what may be triggering your severe asthma symptoms. For example, if you mainly use your inhaler after being outdoors, an environmental trigger like pollen may be causing your asthma to flare up.

2. You’re coughing and wheezing more during the day

Another sign that your severe asthma may be getting worse is if you’re coughing or wheezing more often than usual.

Talk with your doctor about adjusting your treatment plan if you constantly feel like you’re about to cough. Also, speak with them if you find yourself wheezing with a whistle-like sound more than once a day.

3. You wake up coughing and wheezing during the night

If you’re ever jolted awake in the middle of the night by a fit of coughing or wheezing, you may need to modify your asthma management plan.

Properly managed asthma shouldn’t wake you up from sleep more than 1 or 2 nights a month. If you’re losing sleep due to your symptoms more than this, it may be time to discuss treatment modifications with your doctor.

4. There’s been a drop in your peak flow readings

Your peak flow readings measure how well your lungs are functioning at their best. This is usually tested at home with a handheld device called a peak flow meter.

If you’re a peak flow meter user, and your peak flow levels drop below 80% of your personal best, it may be a sign that your severe asthma is poorly managed.

Another sign that your asthma is getting worse is if your peak flow reading varies greatly from day to day. If you notice low or inconsistent numbers, contact your doctor as soon as possible.

5. You often feel short of breath

Another sign that your asthma is getting worse is if you start to feel out of breath even when you’re not doing anything strenuous.

It’s expected to feel winded after exercising or climbing more stairs than you’re used to. But stationary activities like standing, sitting, or lying down shouldn’t cause you to lose your breath.

6. Your chest constantly feels tight

Minor chest tightness is common for people with asthma. But frequent and intense chest tightness can mean your severe asthma is getting worse.

Chest tightness is often the result of the muscles surrounding your airways contracting in reaction to asthma triggers. It may feel as though there’s something squeezing or sitting on top of your chest. If you experience unusually intense chest tightness, particularly while sitting still, speak with your doctor.

7. You sometimes have trouble speaking

If you find it difficult to speak a full sentence without pausing to take a breath, you should make an appointment with your doctor. Trouble speaking is usually the result of an inability to take enough air into your lungs to allow you to let it out at the slow, deliberate rate required for speech.

8. You can’t maintain your normal exercise routine

You may notice that you’re unable to keep up with any type of physical activity if your severe asthma symptoms are getting worse.

Talk with your doctor if you find yourself coughing or using your inhaler more often at the gym or during activities like jogging or playing sports.

If your chest tightens more often during everyday physical activities like climbing the stairs or walking around the block, you may need to change your medications to get your symptoms under control.

Am I having an asthma attack?

The signs of worsening asthma can be uncomfortable but should still be easy enough to manage until you’re able to see a doctor.

If you experience a more sudden and severe onset of symptoms that deviate from your normal symptoms, you may be having an asthma attack or exacerbation. This can include extreme difficulty breathing, wheezing, chest tightness, cough, and shortness of breath, among other symptoms.

If you or someone around you experiences symptoms of an asthma emergency, call 911 or your local emergency number, or go to the nearest emergency department.

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According to the Centers for Disease Control and Prevention (CDC), some of the most common triggers of asthma include:

  • the flu
  • common cold
  • respiratory syncytial virus (RSV)
  • sinus infection
  • allergies
  • pollen
  • air pollution
  • acid reflux
  • bad weather (e.g., thunderstorms, high humidity, very cold air)
  • hyperventilation

If you think that your severe asthma is getting worse, the first thing you should do is make an appointment to see your doctor. Before your appointment, write down a list of the symptoms you’ve been experiencing and bring it with you to review together.

Your doctor will likely listen to your chest and check your peak flow levels to see how they compare with your previous readings. They may also ask you about your routine for taking your asthma medication. Plus, they may check to make sure you’re using the proper technique with your inhaler.

If you’ve been using your inhaler properly and still experience severe symptoms, your doctor may change your treatment plan. They may increase the dose of your inhaler or prescribe an add-on treatment like a leukotriene receptor antagonist (LTRA) tablet or biologic therapy.

In some cases, your doctor may also prescribe a short “rescue” course of oral steroid tablets. These can reduce the amount of inflammation in your airways.

If your doctor does change the dosage of your current medication or prescribe an add-on treatment, consider scheduling a follow-up appointment in 4 to 8 weeks to ensure that your new treatment plan is working.

It’s important to be able to spot the warning signs that your severe asthma is getting worse. This is a vital part of managing your symptoms and may help to prevent a potentially life threatening asthma attack.

Do your best to avoid your asthma triggers, and don’t be afraid to contact your doctor if you think your current treatment isn’t working as well as it should be.