Frequently Asked Questions About Severe Asthma

If you have severe asthma, then you know how challenging it can be to maintain and control. That's why it's so important to understand everything you need to know about your asthma.

In this post, we'll look at some frequently asked questions about severe asthma. We'll also provide some answers that will hopefully help you better manage and control your asthma.

How does asthma affect my breathing?

In people with any type of asthma, the airways become inflamed. As a result, the lining of the airways temporarily swells, making them narrower. The muscles in the airways also tighten. The combination of these two effects makes it harder for air to pass through the airways. This results in asthma symptoms, such as:

• Wheezing
• Chest tightness
• Coughing
• Breathlessness¹

How is severe asthma different?

When you have severe asthma, these symptoms are amplified in intensity. They also occur more frequently, usually every day. Plus the symptoms fail to respond to medication as well as they usually do in people with less severe asthma.

We are not sure why some people have severe asthma while others do not, but experts feel these factors may play a part²:

• High levels of eosinophils, a type of white blood cells that increase inflammation (most common cause)
• Certain chemical or environmental irritants that don't respond to medication
• Being obese
• Not following your asthma treatment plan

How common is severe asthma?

Although more than 25 million people in the U.S. have asthma, a very small minority have severe asthma. Experts estimate that only 5 to 10 percent of all asthmatics are severe.^1,2 So, the chances are quite slim.

How severe asthma compares to other types

As mentioned above, when you have severe asthma, you likely have symptoms every single day. They may even feel as though they never go completely away.  More severe asthma attacks also occur, sometimes requiring emergency care. Your symptoms interfere with sleep, daily life, and work or school. These effects occur even with high doses of asthma medication.

In contrast, here are the effects of other levels:

• Mild intermittent: Symptoms occur less than two times a week and interrupt sleep less than twice a month.
• Mild persistent: Symptoms occur more than two or three times a week and interrupt sleep up to four times a month. They may also interfere with daily life at times.
• Moderate persistent: Symptoms occur daily and interrupt sleep at least weekly.

Is it different for women than it is for men?

Asthma in general is a bit different for women than it is for men. First of all, asthma is more common in women than it is in men. In fact, two-thirds of all asthmatics are female. Here are some other significant differences:

• Females have severe asthma attacks, called exacerbations, more often than males
• Asthma, overall, is more severe in women
• Hospitalization and death from asthma occur more frequently in females than in males
• Women with asthma also tend to have a poorer quality of life than men with asthma do

Experts believe that female hormone levels play a role in these differences.

Is it treated differently from other types?

In general, people who have severe asthma tend to be on more asthma medications than people with milder forms of asthma. They also tend to be on higher doses of those medications.⁴ Frequently, doctors find that combining approaches is the solution to better symptom control with severe asthma.

The types of medicines that can be used for asthma include:

• Inhaled steroids (oral steroids may be used for severe asthmatics)
• Short-acting bronchodilators (quick-relief medicines)
• Long-acting bronchodilators
• Leukotriene receptor antagonists
• Theophylline
• Long-acting muscarinic antagonists⁴

Keep in mind though that severe asthma looks different for each person. There is no one right approach that will work for everyone. It often takes somewhat of a trial and error approach. And it's not uncommon for it to take months, or even years, before the right solution is found. Treating severe asthma is definitely not an exact science.⁴

If traditional asthma medicines don't establish control, your doctor may try one of the newer medicines that have been specifically designed for people with severe asthma. These are called monoclonal antibodies. Some of these types of medicines target IgE and other components of the allergic reaction.⁴ Even newer monoclonal antibody medicines are used as an add-on therapy targeting poorly controlled eosinophilic asthma.

Research is ongoing into new and improved methods of controlling severe asthma.

How to improve severe asthma control

Severe asthma is challenging to manage and control, but with patience and tenacity, it can be done. Some of the things you can do to improve your outcomes include:

• Taking your medicine exactly as prescribed, and keeping your health care team informed as to the effects, both positive and negative
• Doing your best to identify and avoid your triggers
• Becoming a proactive member of the health care team, working closely with the other members

What is the outlook for people with severe asthma?

Asthma is a chronic disease with no known cure. In those with mild to moderate forms of the disease, symptoms come and go, as does the inflammation of the airways. However, in people with severe asthma, inflammation often remains constant. Structural changes in the airways that cause the airway walls to become thicker and narrower may occur.^5,6

But each person is different. Some people will find that once the right treatment is found, their symptoms improve. Others will go through stable times that alternate with out of control times. Some people watch their symptoms slowly worsen over time.

But there is always hope! Work closely with your doctor toward the best quality of life for you.