Severe asthma is a form of the condition that isn’t easily controlled, says Dr. Thomas Slobig, an adult pulmonary physician in private practice in Gilbert, Arizona.
Nationwide, more than 25 million people in the U.S. have asthma, according to the Centers for Disease Control and Prevention. Asthma is a chronic, lifelong disease.
Many people with asthma are able to manage their symptoms by using inhalers. Asthma narrows the airways; inhalers reverse or reduce the narrowing. The two main type of inhalers include preventative inhalers, which prevent inflammation and sensitivity in the user’s airways, and quick-relief inhalers. The latter type relieves muscle tightening around the airways to reduce asthma symptoms. Both types of inhalers widen the user’s airways.
People with severe asthma, on the other hand, typically aren’t able to manage their symptoms with inhalers alone. Rather, they require multiple medications – like inhaled corticosteroids, long-acting bronchodilators, leukotriene modifiers and oral corticosteroids, says Dr. Purvi Parikh, an allergist with the Allergy & Asthma Network. Parikh is based in New York City.
Experts estimate that 5% to 10% of people with asthma have severe asthma, according to the Asthma and Allergy Foundation of America. The exact prevalence is unknown because there isn’t a standard definition for “severe asthma.” However, there are specific indications of severe asthma.
The Need for Multiple Medications
Severe asthma is characterized by the need for multiple medications to control its symptoms, Parikh explains. “So in order to be classified a severe asthmatic, you must be on a combination inhaler – with steroids and a long-lasting beta agonist, at minimum.”
These medications help people with severe asthma manage an array of symptoms that often occur seven days a week, day and night, says Dr. Jack Stewart, a pulmonologist with St. Joseph Hospital in Orange County, California.
If they don’t get treatment, people with severe asthma may have lung function at less than 60% of their normal level, according to the AAFA. A 2017 study conducted by the AAFA found that 84% of people with severe and uncontrolled asthma reported their daily activities were limited because of their disease. Most patients say diminished lung capacity feels like they’re breathing through a straw, Slobig says.
For people experiencing the effects of severe asthma, it’s harder to do things most people take for granted, like carrying groceries a few steps into the house or playing with kids, says Dr. Katherine Janssen, an assistant professor of medicine in the Division of Pulmonary, Allergy, Critical Care and Sleep Medicine at the University of Minnesota Medical School in Minneapolis.
“Because of inflamed airways and bronchospasm (a tightening of the airways in the lungs), it takes longer to breathe out,” Janssen says. “This gets hard because we breathe faster when we’re out of breath.”
If you’re experiencing both inflamed airways and are breathing faster, you’ll have lots of incomplete breaths. This feels like breathing without exhaling completely, which is very uncomfortable. This can lead to emergency department visits, stays in the intensive care unit and even death.
Typical symptoms associated with severe asthma include:
- Shortness of breath.
- Wheezing cough.
- Chest tightness.
- Awakening at night due to asthma.
These asthma symptoms typically worsen at night, according to the AAFA. As a result, sleep is usually interrupted by symptoms. Your physician can identify factors – like acid reflux disease – that may induce or worsen nighttime asthma symptoms, Slobig says.
Medications for severe asthma typically include preventative inhaler therapy, which must be taken on a daily basis, Janssen says.
Asthma that’s difficult to control may be due to reasons other than the disease, according to Dr. Neha Solanki, a pulmonolgist and asthma specialist at Cleveland Clinic. For instance, it could be caused by someone not taking his or her medicines as prescribed or by using asthma inhalers improperly.
Researchers don’t know what exactly causes severe asthma. According to the AAFA, there are several risk factors, which include:
Asthma tends to run in families. However, there isn’t a single gene that determines whether someone has or doesn’t have severe asthma, Janssen says. She also adds that “there isn’t one major cause of asthma. Usually this disease and its severity is what we call ‘multifactorial,’ meaning several different factors play a role” in causing severe asthma.
Among the factors associated with severe asthma, it’s notable that respiratory infections can cause asthma flare-ups, she says.
- Cigarette smoke.
- Dust mites.
- Animal dander.
- Household dust.
- Indoor mold.
- Cold air.
- Aerosols that can be inhaled.
- Sulfites in foods.
Severe asthma can lead to a raft of possible complications, including:
- Death; about 3,600 people in the U.S. die annually from asthma.
- Sudden asthma attacks.
- Hospitalization or an emergency department visit.
- Lack of sleep.
- Risk of flu complications.
- Permanent scarring of the lungs.
Patients who are having frequent symptoms despite using their inhalers the right way should be seen by their primary care physician or a pulmonologist, Janssen says. Some patients may require a “burst” of prednisone, an anti-inflammatory medicine used to treat the flare-ups of asthma. If you continue to have symptoms even while on the prednisone, or if the symptoms come back when you stop using the medication, you and your health care provider can discuss other therapies, she says.
People with severe asthma should be under the care of an asthma and allergy specialist or pulmonologist whenever possible, says Melanie Carver, vice president of community health for the AAFA. These patients should ask their primary care physician for a referral.