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When Is Asthma Considered Severe?

By

Sarah Handzel, BSN, RN

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This content is created or selected by the Healthgrades editorial team and is funded by an advertising sponsor. The content is subject to the Healthgrades medical review process for accuracy, balance and objectivity. The content is not edited or otherwise influenced by the advertisers appearing on this page except with the possible suggestion of the broad topic area. For more information, read the HealthGrades advertising policy.

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In the United States, almost 25 million people live with asthma, a chronic condition that makes it harder to breathe by causing swelling and excess mucus production in the lungs. Most people are easily able to manage their symptoms, but 5 to 10% of people have a more difficult-to-treat form of asthma that causes more severe side effects and complications.

Severe asthma can be a frightening condition, but how do you know if your case is severe? The right information, and a conversation with your doctor, can help you manage your asthma more effectively.

Reduced Lung Function

One of the hallmarks of severe asthma is a reduction in your lung function. When you were first diagnosed, your doctor probably performed several lung function tests to determine how well your lungs work. One of these tests might have been spirometry, which measures how much air you can breathe in and out. This test also measures your forced expiratory volume (FEV1), or how fast you can breathe out.

If you have severe asthma, the results of your spirometry test were probably much lower compared to someone without asthma or with a milder form of asthma. For people with severe asthma, reduced spirometry outcomes have been shown to be related to the severity of the disease, the likelihood that you’ll need to be hospitalized, and how often you’ll have asthma flare-ups.

Frequent Flare-ups

It’s true that anyone with asthma is at risk for asthma attacks, also known as flare-ups or exacerbations. But if you have severe asthma, you might have more flare-ups than usual. Your asthma might already be interfering with your sleep, work, or other activities. Part of managing your condition is learning to avoid potential triggers and use your medications correctly. But for some people, this doesn’t work as well as for others.

Your asthma might be considered severe if you’ve had at least two exacerbations in the previous year, with one of them requiring medical treatment in a hospital. It is common for people with severe forms of asthma to need professional medical help more often, since symptoms can be hard to control. If you’ve ever limited your daily activities for fear of causing a flare-up, or if you ever had to go to the emergency room or another doctor because your asthma was preventing you from breathing comfortably, your condition might be considered severe.

More Intensive Medications

It’s very common for people with asthma to use one or several medications to help prevent symptoms and allow for easier breathing. But most people with severe asthma require many different medications at high doses to manage their condition. If you have severe asthma, control might not be easy, but you can still try to reduce the frequency and severity of your symptoms using medications your doctor recommends. It’s important to keep in mind that you might have to try several medications before finding what works best for you.

Usually, severe asthma requires higher doses of medications to manage symptoms. You might use inhalers or oral medications to help reduce the inflammation in your airways and open your lungs. Also, if your doctor determines your asthma triggers are related to allergies, he or she might prescribe allergy medications.

If you have especially severe symptoms that occur frequently, your doctor might recommend you have a rescue inhaler with you at all times. This type of inhaler can quickly open your airways to help you breathe more easily, but only provides short-term symptom relief. Your asthma might be getting worse if you find yourself using your rescue inhaler more often—check with your doctor if you’re concerned about how often you’re using it.

If you’ve noticed your symptoms are worsening or happening more often, or if your medication doesn’t work as well as it used to, ask your doctor about any testing that can be done to determine the severity of your asthma. Even though severe asthma can be a scary condition, it’s still possible to live a full and happy life by working with your doctor to find ways to control it as much as possible.

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Medical Reviewers: William C. Lloyd III, MD, FACS Last Review Date: Apr 4, 2017

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Medical References

  1. Difficult to Control Asthma: Epidemiology and its Link with Environmental Factors. Current Opinion in Allergy and Clinical Immunology. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4551573/
  2. Asthma Outcomes: Pulmonary Physiology. Journal of Allergy and Clinical Immunology. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4263032/
  3. International ERS/ATS Guidelines on Definition, Evaluation and Treatment of Severe Asthma. American Thoracic Society & European Respiratory Society. https://www.thoracic.org/statements/resources/allergy-asthma/severe-asthma-full.pdf
  4. Living With Asthma. National Heart, Lung, and Blood Institute. https://www.nhlbi.nih.gov/health/health-topics/topics/asthma/livingwith
  5. Asthma: Treatments and drugs. Mayo Clinic. http://www.mayoclinic.org/diseases-conditions/asthma/basics/treatment/con-20026992
  6. How is Asthma Treated and Controlled? National Heart, Lung, and Blood Institute. https://www.nhlbi.nih.gov/health/health-topics/topics/asthma/treatment

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