What is severe asthma?

Asthma is one of the most common chronic pulmonary diseases of varying severity, with a trend of increasing morbidity worldwide. Thanks to modern and effective medication for prevention, most patients have good control of their disease.  However, patients with severe asthma still have symptoms, despite the use of high doses of medication.

Severe asthma is a special form of the disease.  Patients who have severe asthma are treated with high doses of inhaled corticosteroids together with bronchodilators (and often additional medication) and oral corticosteroids in order to control the disease.  Some patients cannot control the disease and have difficulty managing their symptoms, despite using high doses and different types of medicines. Due to frequent symptoms, these patients are unable to complete simple daily activities, they are often absent from work (school), visit doctors and the emergency room, and they get hospitalised due to be possibly life-threatening exacerbations.

Every person with asthma has a unique experience, a chemical reaction in their airways, different triggers of exacerbations, different impact on quality of life and response to treatment. All these facts vary and change over time.

Having asthma is tough at times, but having severe asthma is always tough. However, the right support and treatment can lead to good disease control.

Why does asthma develop?

Asthma is a disease of both children and adults; it can develop at any age.

The exact cause of asthma is still unknown, it is a complex disease in which genetic and external factors cause inflammation and narrowing of the airways, which results in coughing, wheezing in the chest and difficulty breathing.

Severe asthma is an unpredictable condition and is different for each patient. Researchers have not yet determined exactly why some people develop a severe form of the disease. Most patients with severe asthma are elderly, smokers, have had some diagnoses before, but hormonal changes, respiratory infections, bad habits, unhealthy environment are also possible factors.

How common is severe asthma?

An estimated 5-10% of all asthma patients have a really severe form of asthma.

Research has shown another issue – around 50% of patients have poor asthma control, despite the applied treatment.

What is the difference between uncontrolled and severe asthma?

Not all uncontrolled asthma is severe, and not all severe asthma is uncontrolled. People with mild to moderate asthma may also have uncontrolled asthma.

Severe asthma requires secondary care and is not always uncontrolled.

To what extent severe asthma is uncontrolled can be assessed based on the following: the need for medication for disease control, the frequency of symptoms and exacerbations, and the impact of symptoms on daily activities.

Asthma is considered uncontrolled if any of the following apply: you use medicine for quick-relief of symptoms several times during the week, you have frequent symptoms during the day and at night, which affect your quality of life, your personal, professional duties and social activities, you have exacerbations and have to use oral corticosteroids.

Severe asthma symptoms

The symptoms of severe asthma are similar to those of the mild and moderate forms, but they are more intense and more frequent, potentially life-threatening, and do not ease with treatment.

Symptoms and signs are: shortness of breath that is getting worse, tight chest or chest pain, coughing, wheezing that becomes constant.

Symptoms of severe asthma can sometimes be life-threatening, so it is important to recognize when to seek emergency medical help. If your symptoms worsen and the medication for quick-relief of symptoms does not help, call 194 or go to the hospital.

How is severe asthma diagnosed?

Confirmation of an asthma diagnosis includes data from your medical history, spirometry test and other diagnostic procedures (allergy test on the skin, blood and sputum analysis).

Confirmation of severe asthma requires time, review check-ups and diagnostic tests to rule out possible causes of persistent symptoms and other diseases.

Symptoms are unpredictable, they occur during the day and at night, in the form of mild to life-threatening asthma attacks. For many patients, the symptoms are debilitating, preventing them from completing daily activities, especially if they do not use the suggested effective treatment.

According to expert guides for diagnostics and treatment, the characteristics of severe asthma are: frequent daily symptoms that limit daily activities, waking up due to shortness of breath several times a week, frequent exacerbations, use of quick-relief medication several times during the day, FEV1 value (determined by spirometry, which shows how much air a person can exhale from the lungs in one second) below 80%, frequent or continuous use of oral corticosteroids all year round.

Severe asthma is confirmed if the disease is uncontrolled in spite of regularly administered medications. Applied medication, most often used combined are: inhaled corticosteroids, short- and fast-acting bronchodilators, leukotriene inhibitors, theophylline, oral corticosteroids.

Other, very important, factors for assessing how severe and uncontrolled your asthma is: proper use of inhaler (‘pump’), regularity of taking the medication, avoidance of allergens and stress, availability and price of the medication, comorbidities.

The doctor classifies your asthma severity and confirms severe asthma according to how well your symptoms respond to treatment. Severe asthma means that the applied treatment is not managing the symptoms well, after more than 6 months of monitoring.
Confirmation of the diagnosis requires patience and time, from both the patient and the doctor.

How to prevent severe asthma and severe asthma attacks?

The best way of prevention is to follow the recommendations you receive from your doctor:

– Pay attention to the symptoms and apply the recommended therapy regularly.

– If you are a smoker, quit!

– Get vaccinated regularly.

– Inform your doctor if you notice that the medicines are not helping.

– Reduce exposure to allergens and other factors that cause discomfort.

– Wear a mask or scarf if you exercise in cold weather.

– If you are exposed to chemicals at work, apply protective measures.

– Avoid leaving your home when there is air pollution.

– If you are obese, lose some weight.

– Use your quick-relief medicine at the first signs of symptoms, as explained by your doctor.

– USE YOUR MEDICATION REGULARLY, as recommended by your doctor.

Your doctor will present you a treatment plan, advise you on important lifestyle changes and train you on procedures in case your disease gets worse. Share this plan with your family members, professional environment and friends.

Prof. Dr. Biljana Zvezdin,
Institute of Pulmonary Diseases of Vojvodina