Severe Asthma

Severe AsthmaWhat is asthma?
Asthma is a chronic condition of the lungs that involves inflammation and hyperactivity of the airways. With many symptoms and presentations, asthma can be triggered by breathing allergens from the environment such as pollen, dust, animal dander, mold, or other irritants. Some of these irritants include pollutants, perfumes, and microbes which can cause uncomfortable and sometimes life-threatening reactions. The symptoms of asthma can include chronic and recurrent cough, wheezing, shortness of breath, chest tightness or pressure, straining of neck and chest muscles, rapid breathing, and changes in heart rate. If an asthma attack is severe enough, patients may require hospitalization. Very rarely, severe asthma can be fatal.
 
Who has severe asthma and how it is diagnosed?
Severe asthma is defined as someone diagnosed with asthma requiring medium or high-dose inhaled corticosteroids combined with other longer-acting medications. Asthma is also considered severe when it is uncontrolled despite proper use of these medications. Individuals who suffer from severe uncontrolled asthma experience symptoms throughout most days and every night. These patients often require the frequent use of inhaled medications or even daily oral steroids to provide rescue from their asthma symptoms. Severe asthma may impact daily activities, resulting in missing work or school, and can directly affect a patient’s quality of life. Patients with severe asthma often demonstrate significant reduction of their lung function when tested by spirometry or a pulmonary function test (PFT).
 
What are my treatment options?
When the severity of asthma symptoms is mild or moderate, it can be managed with medications such as low/moderate dose steroid inhalers, a combination of oral steroids and long-acting inhalers. It is important that anyone with asthma, and especially severe asthma, stop smoking and be aware of any triggers, such as allergens, that may be contributing to their symptoms. Severe asthmatics require higher doses of the inhalers and often require medications (anticholinergics) that relax the muscles around the airways making it easier to breathe. Long-term usage of combination inhaled controller medications may not be sufficient for the treatment of severe asthmatics and long-term use of oral steroids carries the risk of increased side effects.

In the past few years, injection medications have been approved for the treatment of severe asthma, known as “biologics”. Biologics are administered under the skin (subcutaneously) or intravenously at a bi-weekly, monthly or bi-monthly basis depending on the product. Some need to be given in the doctor’s office or specialized center, while others can be given at home. These medications work by targeting specific cells or chemical messengers in the body involved in the inflammatory response including immunoglobulin E (IgE), the antibody that can be measured in severe allergic-asthma, and eosinophils, cells involved in allergic or type-2 immune responses in severe eosinophilic asthma. In the lungs these medicines can reduce airway hyperactivity significantly and may allow patients to reduce or even discontinue long-term oral steroid use. They also reduce the number of asthma attacks or flares over the course of treatment. Biologics have provided significant success in managing severe asthma and are usually administered under the care of a specialist.

How should I try to get help?
The best option when choosing a physician to manage severe asthma is to contact an allergy / immunology specialist. An allergist / immunologist has the relevant knowledge, training, and skills necessary to properly diagnose and manage asthma. With the help of your physician, you can take control of your asthma and return to living a normal, healthy and active life.  

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This article has been reviewed by Andrew Moore, MD, FAAAAI

Reviewed Date: 7/29/19

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