For most people with asthma, inhalers and other standard forms of therapy can prevent or limit breathing problems and other symptoms. But for those with severe asthma, the usual treatments don’t get the job done.
If someone experiences asthma symptoms more than twice a week, their asthma is termed “persistent.” And among those with persistent asthma, doctors further categorize the condition as mild, intermediate, or severe.
“The symptoms of severe asthma are similar to those of mild asthma, they’re just more frequent and more severe, and require more medications to keep them under control,” says Emily Pennington, MD, a pulmonologist and asthma specialist at the Cleveland Clinic in Ohio.
By definition, people with severe asthma require either a high-dose inhaled corticosteroid, plus a second form of medication; or they require systemic (oral) corticosteroids to manage their symptoms. The term “severe asthma” also applies to people whose symptoms don’t respond well to these forms of treatment. This type of severe asthma is also sometimes called “uncontrolled asthma.” (1)
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Severe Asthma Attacks Can Resemble Milder Attacks; They Can Also Be Medical Emergencies
Severe asthma attacks vary from person to person. But for many, symptoms resemble those of milder forms of asthma. Those symptoms just come on more frequently — for many, multiple times a day — and they don’t respond well to medication, Dr. Pennington explains.
- Trouble breathing
- Trouble speaking due to shortness of breath
- Chest tightness
For other people with severe asthma, an attack may produce symptoms that require emergency medical attention. These include: (4)
- Difficult and rapid breathing
- Very pale or blue lips, fingers, or skin coloring
- Rapid movement of nostrils
- Ribs and stomach sucking in and pushing out rapidly and noticeably
- A chest that expands while taking a breath, but doesn’t deflate
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What Causes Asthma to Be Severe?
It’s not clear why some people with asthma have more severe or harder-to-control symptoms. But there are a few theories, according to the nonprofit Asthma UK: (5)
- The lung’s airways are so inflamed that normal medications don’t work.
- The chemical molecules or other asthma triggers that cause a person’s symptoms aren’t effectively blocked by current medications.
- A person has a mild and undiagnosed form of asthma that gets worse over time due to lack of treatment.
What Are the Symptoms of Severe Asthma?
On a day-to-day basis, the symptoms of severe asthma resemble the symptoms of other forms of asthma. The difference is that people with severe asthma tend to suffer attacks daily. Also, the attack’s symptoms are severe, and they either don’t respond well to therapy or they require a combination of therapies — including a form of corticosteroid treatment. The symptoms of severe asthma include trouble breathing, wheezing, a persistent cough, and chest tightness or pain. (2,3)
RELATED: What Are the Signs and Symptoms of Asthma?
People with severe asthma are also much more likely to experience bluish lips or skin, extreme breathing difficulties, or other symptoms that require emergency medical attention. (4)
Doctors Diagnose Severe Asthma With a Series of Lung Function Tests and by Determining the Severity and Frequency of Your Symptoms
Dr. Pennington says severe asthma is diagnosed in part on the basis of the symptoms and criteria mentioned above. So if someone’s asthma symptoms are classified as persistent (experienced at least twice per week or more frequently) and if they don’t respond well to therapy, that person may be diagnosed with severe asthma.
Along with assessing symptoms and conducting a physical exam, most doctors will perform some kind of “objective” lung-function test in order to diagnose severe asthma. This test could take several forms, including: (2,6,7)
- Spirometry, which measures how much air you can inhale and exhale
- Peak air flow, which measures how well air flows in and out of the lungs
Results from these tests can help your doctor determine if your symptoms should be categorized as severe asthma.
Severe Asthma Treatment Usually Includes Inhalers and Oral Medication (if Needed)
By definition, many people with severe asthma will be treated with a mixture of inhaled corticosteroids (inhalers) and some other form of medication. Some may also, or alternatively, require oral corticosteroid medications. (8)
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Inhaled corticosteroids work by calming lung inflammation. Oral corticosteroids do the same thing, but they can sometimes work better than inhaled corticosteroids — especially if a person isn’t responding well to inhaled medications. But these corticosteroids can come with side effects, including: (9)
- Weight gain
- Mood swings
- High blood pressure
- Brittle bones and bone fractures
- Elevated infection risks
Can You Prevent Severe Asthma?
Again, experts aren’t sure why some people develop severe asthma and others don’t. That makes preventing severe asthma difficult.
There is some evidence linking air pollution to moderate and severe asthma. It’s possible that people with asthma who are able to avoid air pollution — like the kind caused by heavy vehicle traffic — may avoid symptoms of severe asthma, according to the Asthma and Allergy Foundation of America. (10) It’s also possible that taking care to manage mild asthma symptoms could prevent your condition from growing more severe.
But as of right now, there’s no known effective way to protect yourself from severe asthma.
Can People Recover From Severe Asthma?
Doctors are developing new therapies to help people manage severe asthma. For example, biologics — drugs made from living cells that can turn down or “moderate” the body’s immune system reactions — can help some people with severe asthma better control their symptoms, according to information from the Academy of Allergy Asthma & Immunology. (11)
Dr. Pennington also says that, for reasons that aren’t well understood, severe asthma can become milder in some people as time passes.
But there’s no well-defined recovery pathway for people with severe asthma. Every individual with this type of asthma is different.
Here Are the Answers to These Severe Asthma FAQs
Is Severe Asthma a Disability?
In some cases, yes, severe asthma is a disability. Specifically, if your severe asthma causes frequent hospital visits even when you follow your doctor’s treatment plan, you may qualify for disability benefits. (12)
Can Severe Asthma Cause COPD and Other Complications?
Severe asthma and chronic obstructive pulmonary disease (COPD) are two different conditions, and one doesn’t cause the other. But in some people, these conditions overlap. This is known as asthma-COPD overlap syndrome. (13)
While severe asthma isn’t thought to cause COPD, it can lead to other complications. These include:
- Poor sleep
- Weight gain
- Airway remodeling, which refers to the harmful scarring or other irreversible changes to the lung’s airways
- Anxiety or depression
- Increased risk for reflux (GERD) or obstructive sleep apnea
Can a Severe Asthma Attack Cause Permanent Damage?
Over time, asthma-related inflammation can cause permanent lung damage. This damage includes airway remodeling, which is a kind of lung scarring that makes breathing more difficult and medications less effective. Airway remodeling is a risk for people with severe asthma, and attacks can contribute to this type of damage. (14)