Severe asthma presents many of the same symptoms as other asthma. But it can be life threatening. You can work with your healthcare team on medications or lifestyle changes to help manage your condition.

Asthma is an inflammatory lung disease that can cause mild to severe symptoms. In most cases, avoiding triggers, taking daily medications, and using other treatment options can help you manage your asthma.

But if your asthma does not remain well managed via any type of treatment, this typically means you have severe asthma. Having severe asthma may also mean you need high doses of inhaled corticosteroids or long-term oral corticosteroids in addition to other daily medications.

Some doctors have differing opinions on the definition of severe asthma. The World Health Organization (WHO) has categorized asthma in three ways:

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

While severe asthma can be difficult to treat, it’s still possible to manage it. Keep reading to learn the symptoms of severe asthma, signs of an attack, and treatments to manage your condition.

The symptoms of severe asthma are similar to the symptoms of mild to moderate asthma. But severe asthma symptoms tend to be more intense, potentially life threatening, and difficult to manage with asthma treatments.

Signs and symptoms of severe asthma may include:

  • shortness of breath that continues to worsen
  • pain or tightness in your chest
  • cough that may be dry or with excess mucus
  • wheezing that persists after treatment

Since severe asthma can sometimes be life threatening, make sure you know when to seek emergency medical care. If you have shortness of breath that occurs when doing simple physical activities or quickly gets worse, call 911 or go to a hospital.

If a quick-relief inhaler does not help either, you may need emergency treatment.

If you have severe asthma, your symptoms will tend to be severe, persistent, and difficult to manage, according to guidelines the Global Initiative for Asthma (GINA) developed. The WHO and National Heart, Lung, and Blood Institute created GINA in 1993.

Severe asthma either does not respond to treatments and medications at all or is very difficult to treat. This lack of response to medications is known as therapy-resistant, or treatment-resistant, asthma. It may be because your asthma has become resistant to corticosteroids or other medications used to treat asthma.

A doctor might give a diagnosis of severe asthma if you:

  • have needed treatment with high dose inhaled steroids and a long-acting beta-agonist (LABA), or leukotriene modifier or theophylline in the past year
  • have needed systemic glucocorticoids for half a year or more to manage symptoms
  • have no other conditions or factors that could explain the symptoms

If your asthma is not responding to medications, talk with your doctor regarding diagnosing why it’s not responding and discussing alternative treatment options.

They will check to see if you have other conditions that may be mimicking asthma, such as angina and heart failure. They will also examine you for complications of severe asthma, such as chronic infections and allergic bronchopulmonary aspergillosis.

If you have severe asthma, your doctor will work with you to develop a treatment plan. This may include medications and lifestyle changes, along with natural remedies.

Medications and treatments that a doctor may prescribe to treat severe asthma can include:

  • corticosteroid injections
  • higher doses of inhaled corticosteroids
  • azithromycin (a macrolide antibiotic), prescribed as a low dose over a longer period of time
  • inhaled corticosteroids more frequently
  • continuous inhaled nebulizer
  • ipratropium bromide aerosols
  • long-acting beta-agonists (LABAs)
  • montelukast
  • theophylline
  • oral corticosteroids
  • biologics
  • oxygen therapy

The medications listed above may be used alone or in combination to try to get your severe asthma to a manageable place.

According to research published in 2019, the following lifestyle measures may help with severe asthma symptoms:

  • removing or avoiding suspected and known triggers such as any allergens or exposure to environmental irritants like chemicals whenever possible
  • staying physically active to help strengthen your lungs and general health
  • managing your weight with your doctor’s support if you have obesity
  • stopping smoking if you smoke and avoiding secondhand smoke
  • practicing meditation, yoga, and breathing exercises, which research suggests may help adults with asthma as research continues to reach more conclusive findings and recommendations
  • considering discussing massage therapy with your child’s doctor because research suggests it might be beneficial in helping them with asthma as research continues to reach more conclusive findings and recommendations

Research indicates these lifestyle measures can be beneficial for people with asthma. However, study authors note that more research is needed regarding lifestyle interventions and asthma, as research can be inconclusive and vary depending on various factors.

While natural treatments should not replace your asthma medications, you may benefit from certain natural options in addition to your prescribed treatments.

Examples of natural, herbal remedies may include:

  • black seed
  • choline
  • caffeine

While research on specific herbs isn’t always conclusive, there is evidence — along with centuries of practicing Chinese medicine and alternative medicine — that herbal remedies can help with lung function and benefit those with severe asthma.

Other natural treatments considered lifestyle changes may also be beneficial, including cupping, acupuncture, and massage therapy.

More research is needed on many alternative treatments and their effects on severe asthma symptoms.

It’s always important to discuss any herbs or supplements you’re thinking of taking with your doctor before starting them.

The symptoms of a severe asthma attack can include:

  • severe shortness of breath where you have trouble speaking
  • rapid breathing where your chest or ribs visibly have retractions
  • strain on your chest muscles and working hard to breathe
  • rapidly moving nostril flares when inhaling and exhaling
  • color changes in the face, lips, or fingernails that typically lead to a pale or bluish appearance
  • difficulty inhaling or exhaling fully
  • symptom-resistance to rescue inhalers
  • inability to perform usual activities
  • infant’s inability to recognize or respond to their parents

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 American Lung Association cites traffic light colors to indicate the three peak flow zones: green, yellow, and red. These different zones reflect how your lungs are functioning and what may be happening with your airways, to affect your asthma symptoms.

  • Green, “Go”: This is 80–100% of your usual or normal peak flow rate. It signals an all-clear. A reading in this zone means that your asthma is well managed. Your doctor likely recommends that you keep using the medications as directed.
  • Yellow, “Caution”: This is 50–80% of your usual or normal peak flow rate. This zone indicates that your airways are narrowing. Your healthcare team may advise you that taking additional actions, such as adding more medications or treatments, is necessary.
  • Red, “Stop”: This zone refers to anything below 50%, and it means you have severe airway narrowing. This is considered a medical emergency, and you should get medical help right away.

Your healthcare team may have their own guidelines or specific ranges that they follow. They can help you create an asthma action plan and address any changes in symptoms.

Severe asthma usually requires long-term treatment and medical management.

Since severe asthma can be difficult to treat, the recovery time following a severe asthma attack varies based on your individual situation and the length of time it takes to get the severe asthma attack to a manageable place.

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 help as soon as possible during a severe asthma attack.

To help speed up your recovery, try to rest as much as you can. You may feel physically and emotionally exhausted, so take a day or more to relax and do not extend your activities beyond your healthcare team’s recommendations.

Also, your doctor will likely schedule a follow-up appointment as soon as possible so they can review your symptoms and medications and adjust as needed. They can also give you recovery tips, update your asthma action plan to help prevent another attack, and answer any questions you may have.

The best way to help prevent severe asthma and severe asthma attacks is to follow the treatment plan your doctor prescribes. If your current plan is not working, let your doctor know. You can then work together to adjust it.

Here are some other ways to help you prevent severe asthma and severe asthma attacks.

  • Track your symptoms and use medications regularly to manage them.
  • If you smoke, consider getting help quitting.
  • Get routine vaccinations for whooping cough, pneumonia, the flu. There may be other vaccinations your doctor may recommend based on your specific situation.
  • 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 face mask when you exercise in cold weather.
  • If your job involves handling chemicals, take recommended proper precautions.
  • Avoid going outside on days with poor air quality.
  • Talk with your doctor about a weight management plan if they deem it necessary.
  • Use your rescue inhaler as instructed at the first signs of an asthma attack.
  • Use your daily medications, including allergy treatments and other medications, as directed.

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.

It’s important that you share this plan with your support network, which may include family, friends, and co-workers. By sharing your plan, they’ll be able to help you if you experience an attack.

What happens if you have severe asthma?

With severe asthma, usual medications will not bring relief. The symptoms will also be more extreme and last longer than they usually do with asthma. You will need to work closely with a doctor, following your treatment plan, and you may need to try several treatment combinations before finding one that works for you.

How do I know if I have severe asthma?

If you have asthma that does not respond to typical asthma therapy, you may have severe asthma.

Can severe asthma go away?

Severe asthma is typically a long-term condition. However, the Asthma and Allergy Foundation of America notes that around half of children with asthma “grow out of” it by the time they reach adulthood.

As their bodies develop, their airways mature and respond more effectively to airway inflammation and irritants. Their symptoms can decrease and sometimes disappear completely by the time they start school, especially if they only wheezed during viral infections and there’s no family history of allergic reactions.

But some temporarily outgrow it and then experience it returning when they’re older.

Can you live a normal life with severe asthma?

Yes, you can live a normal life.

The treatment goal is to get your asthma to a manageable place, so it’s important to consistently adhere to your doctor-prescribed treatments and lifestyle recommendations.

If you feel that your treatments are not working as they should be, discuss your concerns with your doctor. They can review treatment options.

Regularly seeing your doctor can help ensure that you continually have the best treatment plan for effectively managing your severe asthma.