May is Asthma Awareness Month.
Coughing. Wheezing. Shortness of breath. All things on our not to-do list.
But if you have asthma, you’re all too familiar with these symptoms and the many ways asthma can affect everyday life.
Asthma causes inflammation in the airways, and the symptoms range from mild to severe. While most people with asthma can take medications to reduce inflammation, people with severe asthma have a harder time controlling symptoms, which can be life-threatening.
Severe asthma can develop at any age, and women are more likely to have severe asthma than men. But you can breathe a little easier knowing a proper diagnosis and treatment plan can help improve overall health and quality of life.
What is severe asthma?
By definition, severe asthma is asthma that requires a combination of high-dose inhaled steroid medications (corticosteroids) and longer-acting medications to help treat symptoms.
Asthma is also considered severe if symptoms go on even when taking the proper medications.
People with severe asthma tend to have reduced lung function and more intense symptoms compared to people with mild or moderate asthma. People with severe asthma also experience more asthma attacks — when symptoms rapidly get worse or build up over a few hours and don’t respond to a fast-acting inhaler.
Signs of an asthma exacerbation or attack can include:
- Severe chest tightness or pain
- Shortness of breath when talking
- Inability to speak in full sentences
- Needing quick-relief medications more frequently
The types of severe asthma
There are different types of severe asthma:
- Allergic asthma: Symptoms are triggered by allergens such as mold, pollen, dust mites and pet dander.
- Nonallergic asthma: Symptoms are caused by air pollution, tobacco smoke, viruses and exercise.
- Eosinophilic asthma: Involves high levels of a white blood cell called eosinophils and Type 2 inflammation, which is an overactive immune response that causes inflammation.
- Neutrophilic asthma: Involves inflammation not related to Type 2 inflammation and high levels of neutrophilic white blood cells. This type of asthma is resistant to corticosteroid treatment.
Knowing what type of asthma you have is important to finding the right treatment plan for you.
The difference between severe asthma and uncontrolled asthma
Some people with asthma may think they have severe asthma but in reality, severe asthma is rare — only about 5%–10% of asthma cases are severe asthma.
But 3 out of 5 people with asthma have uncontrolled asthma.
On paper, severe asthma and uncontrolled asthma have similar symptoms, like persistent coughing and wheezing and symptoms that wake you up during the night.
But the difference is that symptoms of uncontrolled asthma improve with medication and lifestyle changes to avoid triggers. Severe asthma symptoms remain uncontrolled or happen often, even when taking the maximum, high-dose medications.
It’s important to tell your healthcare provider (HCP) if you’re not seeing improvement with your breathing after using a rescue inhaler, if your chest muscles feel tired and if you get shortness of breath when you’re talking because these are all signs of severe asthma.
Tracking your symptoms is key to finding the best treatment for severe asthma
Treatment for severe asthma depends on a number of different factors, so it’s a good idea to keep a journal of your symptoms and how those symptoms affect your everyday life.
Start by tracking symptoms on a day-to-day basis and note any identifiable triggers. For example, if you’re experiencing shortness of breath when talking, write it down along with any triggers like stress. Also note the frequency: Does this happen often? Is it getting worse?
Other notable factors that can affect the severity of asthma symptoms can include:
- Health conditions like COPD that can affect breathing
- Certain medications
- Improper use of an inhaler
- Irritants or allergens
Keeping a journal can help you and your HCP get an accurate picture of the severity of the disease and identify treatment goals as part of the shared decision-making process.
Pulmonologist vs. allergist for severe asthma
People with severe asthma need to see a specialist — typically a pulmonologist or allergist — for personalized care.
A pulmonologist specializes in the respiratory system and can diagnose, treat and manage severe asthma that is not controlled or has unknown triggers.
Allergists also specialize in treating asthma and asthma that’s triggered by environmental factors.
Treatments for severe asthma
Severe asthma means dealing with a constant level of inflammation in the airways, and treatment usually requires a combination of different medications depending on the type of asthma and triggers for the disease. Treatments can be delivered through an inhaler or nebulizer, in a pill, or by injection or infusion.
Treatments for severe asthma can include:
- Bronchodilators to relax muscles around the airways
- Long-acting beta2-agonists (LABAs)
- Long-acting muscarinic antagonists (LAMAs)
- Anti-inflammatory medications, including steroids, to help reduce inflammation
- Inhaled corticosteroids (ICS) are medications that can be used long-term to manage symptoms and prevent asthma attacks.
- Oral corticosteroids (OCS), also called oral steroids, are pills or medications in liquid form that reduce swelling and inflammation in the body to treat an asthma attack or to treat chronic, severe cases. These medications are only prescribed for short-term use because the side effects can be serious.
- Biologics, which are injectable medications that work by targeting cells or chemical messengers in the body that cause the inflammatory response in the lungs and airways
- Other medications that can be used as add-ons to the above treatments
- Macrolide antibiotics for non-Type 2 inflammation, which control the number of white blood cells in the airways to reduce symptoms
- Bronchial thermoplasty, a procedure that uses heat to reduce the amount of smooth muscle tissue for less airway constriction and may reduce attacks
- Leukotriene modifiers, prescription medications that reduce or block the production of inflammatory chemicals called leukotrienes that cause bronchial constriction
- Cromolyn sodium, a nasal medication that prevents swelling in the air passages of the nose usually caused by allergies
Lifestyle factors also play a role in the treatment for non-Type 2 inflammation severe asthma.
For people with non-Type 2 inflammation, changes may include:
- Reducing exposure to environmental chemicals and allergens
- Keeping your home allergen-free with certain products (air purifiers, microfiber dusters, HEPA vacuums, etc.) and avoiding pet dander
- Quitting smoking and avoiding secondhand smoke
- Maintaining a healthy weight
Talk to your healthcare provider if you’re having asthma symptoms
Severe asthma is a complex disease, but there are treatment options that can help reduce inflammation and increase your quality of life. So, if you’re experiencing symptoms or if you think your asthma is getting worse — talk to your HCP right away.
This educational resource was created with support from GSK, a HealthyWomen Corporate Advisory Council member.
