May is Asthma Awareness Month.
Cough. Panting. Shortness of breath. All things on our not-to-do list.
But if you have asthma, you are all too familiar with these symptoms and the wide range of effects that asthma can have on everyday life.
Asthma causes inflammation of the airways and symptoms range from mild to severe. While most people with asthma can take medication to reduce inflammation, people with severe asthma have a harder time controlling symptoms, which can be life-threatening.
Severe asthma can occur at any age, although it affects women more often than men. But you can breathe a little easier knowing that 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 treat symptoms.
Asthma is considered serious even if symptoms persist even when taking the right medication.
People with severe asthma tend to have reduced lung function and more severe symptoms compared to people with mild or moderate asthma. People with severe asthma are also more likely to have asthma attacks – when symptoms worsen quickly or worsen over a few hours and do not respond to a fast-acting inhaler.
Signs of an asthma exacerbation or attack may include:
- Severe chest tightness or pain
- Shortness of breath when speaking
- Inability to speak in complete sentences
- They need medication more often for quick relief
The types of severe asthma
There are different types of severe asthma:
- Allergic asthma: The symptoms are triggered by allergens such as mold, pollen, dust mites and animal hair.
- Non-allergic asthma: Symptoms are caused by air pollution, tobacco smoke, viruses and exercise.
- Eosinophilic asthma: It involves high levels of white blood cells called eosinophils and type 2 inflammation, which is an overactive immune response that causes inflammation.
- Neutrophilic asthma: Includes inflammation unrelated to type 2 inflammation and high levels of neutrophil white blood cells. This type of asthma is resistant to treatment with corticosteroids.
To find the right treatment plan for you, it’s important to know what type of asthma you have.
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, such as persistent coughing and wheezing as well as symptoms that wake you up at night.
The difference, however, is that symptoms of uncontrolled asthma improve with medication and lifestyle changes to avoid triggers. Severe asthma symptoms remain uncontrolled or occur frequently, even with maximum, high-dose medication intake.
It is important to tell your doctor if your breathing does not improve after using a rescue inhaler, if your chest muscles feel tired, and if you become short of breath when speaking, as these are all signs of severe asthma.
Read: Is your asthma under control? >>
Tracking your symptoms is key to finding the best treatment for severe asthma
Treatment for severe asthma depends on a number of different factors. Therefore, it is a good idea to keep a diary about your symptoms and how these symptoms affect your everyday life.
Start by tracking symptoms daily and noting any identifiable triggers. For example, if you feel short of breath while speaking, write this down along with any triggers such as stress. Also consider the frequency: Does this happen often? Is it getting worse?
Other important factors that can affect the severity of asthma symptoms may include:
- Health conditions such as COPD, which can affect breathing
- Certain medications
- Improper use of an inhaler
- Irritants or allergens
Keeping a diary can help you and your doctor get an accurate picture of the severity of the condition and set 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 individualized care.
A pulmonologist specializes in the respiratory system and can diagnose, manage, and manage severe asthma that is uncontrolled or has unknown triggers.
Allergists also specialize in treating asthma and asthma triggered by environmental factors.
Treatments for severe asthma
Severe asthma means that the airways are constantly inflamed. Treatment usually requires a combination of medications, depending on the type of asthma and what triggers the condition. Treatment can be given via an inhaler or nebulizer, in a tablet, or by injection or infusion.
Treatments for severe asthma may include:
- Bronchodilators to relax the muscles around the airways
- Long-acting beta2 agonists (LABAs)
- Long-acting muscarinic antagonists (LAMAs)
- Anti-inflammatory medications, including steroids, to reduce inflammation
- Inhaled corticosteroids (ICS) are medications that can be used long-term to relieve 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 chronic, severe cases. These medications are prescribed for short-term use only as side effects can be serious.
- Biologics are injectable medications that target cells or chemical messengers in the body that trigger an inflammatory response in the lungs and airways
- Other medications that may be used as an adjunct to the above treatments
- Macrolide antibiotics for non-type 2 inflammation, which control the number of white blood cells in the airways to relieve symptoms
- Bronchial thermoplasty, a procedure that uses heat to reduce the amount of smooth muscle tissue to reduce airway narrowing and reduce seizures
- Leukotriene modifiers, prescription medications that reduce or block the production of inflammatory chemicals called leukotrienes, which cause narrowing of the bronchial tubes
- Cromolyn sodium, a nasal medication that prevents swelling in the nasal airways usually caused by allergies
Lifestyle factors also play a role in the treatment of severe asthma without type 2 inflammation.
People with non-type 2 inflammation may experience the following changes:
- Reducing exposure to environmental chemicals and allergens
- Keep your home allergen-free and avoid pet hair with certain products (air purifiers, microfiber dusters, HEPA vacuums, etc.).
- Quit smoking and avoid passive smoking
- Maintain a healthy weight
Talk to your doctor if you have asthma symptoms
Severe asthma is a complex condition, but there are treatment options that can help reduce inflammation and improve your quality of life. So if you experience symptoms or think your asthma is getting worse, talk to your doctor immediately.
This educational resource was created with support from GSK, a member of the HealthyWomen Corporate Advisory Council.
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