More people in the United States have been diagnosed with asthma than ever before. Doctors don’t know why this is, but some theories include the increase of allergens in the air, more pollution, the possible overuse of antibiotics or just that we are more aware of asthma than we were in the past. Regardless of what causes asthma, the condition can be quite severe if it’s not well controlled. Severe asthma could affect your quality of life and result in multiple visits to the emergency room. But what is severe asthma, and how is it different from the other types? The Different Types of Asthma There are several levels or grades of asthma. The levels refer to how often asthma symptoms occur and how well the lungs function. However, anyone with any grade of asthma can go into serious, even life-threatening, respiratory distress. Intermittent asthma: Symptoms occur twice a week or less and they do not generally affect quality of life. Mild persistent asthma: Symptoms are more frequent, at least twice a week, but not more often. A person with mild persistent asthma has about 80% or better lung function without treatment. Moderate persistent asthma: Symptoms occur every day and flare-ups (more severe symptoms that interfere with activity) can last several days. A person with moderate persistent asthma has about 60% to 80% of normal lung function when not receiving treatment. Severe persistent asthma: Symptoms occur every day and can affect every day activities. People with severe persistent asthma have about 60% of lung function without treatment. Severe asthma is not the same thing as intermittent asthma attacks that are severe, even if the attacks are severe enough to be hospitalized. People with severe asthma have difficulty breathing or symptoms of asthma most of the time, with little relief, despite treatment. “Poorly Controlled Asthma” Severe asthma may be called “poorly controlled asthma” by some doctors. This doesn’t refer to how well someone follows their prescription but rather indicates that treatment with asthma therapy does not improve symptoms or prevent flare-ups. You may be diagnosed with severe asthma if your disease isn’t controlled and you can’t breathe properly with standard asthma medication, despite taking the prescribed dose at the prescribed times. These medications could include high doses of inhaled glucocorticosteroids or long-term treatment with corticosteroids by mouth, usually prednisone. Treating Asthma Mild or moderate asthma is often treated only when symptoms occur. This may involve taking rescue medications, such as drugs that open the airways like inhaled albuterol and bronchodilators, or corticosteroids, which reduce inflammation. Treatment for flare-ups may include oral or intravenous (IV) corticosteroids, which may be needed for several days to reduce the inflammation in the respiratory tract. Treatment for severe asthma requires a more long-term approach, not just treatment during flare-ups. For example, if you have severe asthma, you may need: Maintenance medications, such as inhaled corticosteroids every day Short-acting bronchodilator inhalations, which open the airway and relieve symptoms as you use them Long-acting bronchodilator inhalations, which last longer than short-acting bronchodilators Anti-inflammatory medications to reduce inflammation in the airway Inhaled medications for severe asthma may be more effective if they are inhaled through mist using a machine called a nebulizer, rather than an inhaler or puffer. Nebulizers help ensure you breathe in the medication as required. Eosinophilic Asthma Asthma generally develops during childhood, although it can start in adulthood. Adults who develop asthma are often diagnosed with a subtype of asthma called eosinophilic asthma. This type of asthma can be difficult to control and quite severe. Unlike other asthma, eosinophilic asthma does not have the typical triggers, such as allergies, to cause symptoms. The severity of eosinophic asthma also affect lung function. People with this type of asthma tend to lose lung function more quickly. In eosinophilic asthma, tiny white blood cells called eosinophils are produced in larger numbers than usual, creating inflammation in the respiratory tract. Treatment for eosinophilic asthma includes the standard treatment to reduce and treat symptoms and flare-ups. In addition, new medications called leukotriene modifiers and biologics may help by specifically target the eosinophils, preventing flare-ups. Status Asthmaticus A condition called status asthmaticus refers to a severe flare-up that does not respond to first attempts for treatment. Most asthma flare-ups can be managed with medications, either oral, intravenous (IV), or inhaled, although if you have a serious flare-up, you may need treatment in an emergency department or a few days-long hospital stay. Severe asthma can significantly affect your quality of life. Having constant symptoms of coughing, wheezing, and shortness of breath can make it difficult to participate in work and leisure activities. If you have asthma and you find your current treatments don’t allow you to breathe normally, speak with your doctor about adjusting your treatment plan. Asthma is not curable, but it is manageable for most people, although it may take some trial and error to find the right treatment plan for you.