May is Asthma Awareness Month.
cough. Wheezing. Difficulty breathing. our everything ~ no To-do list.
But if you have asthma, you’re probably familiar with all of these symptoms and the many ways they can affect your daily life.
Asthma causes inflammation of the airways and symptoms can range from mild to severe. Most asthma patients can take medications to reduce inflammation, but those with severe asthma have difficulty controlling their symptoms, which can be life-threatening.
Severe asthma can occur at any age, and women are more likely to have severe asthma than men. But you can feel a little more comfortable knowing that a proper diagnosis and treatment plan can help improve your overall health and quality of life.
What is severe asthma?
By definition, severe asthma is asthma that requires a combination of long-acting medications and high doses of inhaled steroid medications (corticosteroids) to help treat symptoms.
Asthma is considered serious if symptoms persist despite taking appropriate medications.
People with severe asthma tend to have reduced lung function and more severe symptoms than people with mild or moderate asthma. People with severe asthma also experience more asthma attacks. That is, if symptoms worsen rapidly or build up over several hours and do not respond to short-acting inhalers.
Signs of an asthma exacerbation or attack include:
- Severe chest tightness or pain
- Shortness of breath when speaking
- unable to speak in complete sentences
- If you need short-acting medications more often
Types of Severe Asthma
There are several types of severe asthma.
- Allergic Asthma: Symptoms are triggered by allergens such as mold, pollen, dust mites, and pet dander.
- Non-allergic asthma: Symptoms are caused by air pollution, cigarette smoke, viruses, and exercise.
- Eosinophilic asthma: It is associated with high levels of white blood cells called eosinophils and type 2 inflammation, an overactive immune response that causes inflammation.
- Neutrophilic asthma: It is associated with inflammation and high levels of neutrophilic white blood cells that are not associated with type 2 inflammation. This type of asthma is resistant to corticosteroid treatment.
It’s important to know what type of asthma you have to find the right treatment plan for you.
Differences between severe asthma and uncontrolled asthma
Some people with asthma may think they have severe asthma, but severe asthma is actually rare. Only about 5 to 10 percent of asthma cases are severe asthma.
However, three out of five people with asthma have uncontrolled asthma.
On paper, severe and uncontrolled asthma have similar symptoms, including persistent coughing, wheezing, and night wakings.
However, the difference is that the symptoms of uncontrolled asthma improve through medication and lifestyle changes to avoid triggers. Severe asthma symptoms are uncontrolled or occur frequently even when taking the highest doses of medication.
It is important to tell your health care provider (HCP) if your breathing does not improve after using a rescue inhaler, if your chest muscles become tired, or if you become short of breath when speaking, as these are all signs of serious asthma.
Read more: Is Your Asthma Under Control? >>
Tracking your symptoms is important in finding the best treatment for severe asthma
Treatment for severe asthma depends on many factors, so it’s a good idea to keep track of your symptoms and how they affect your daily life.
Start by tracking your symptoms each day and note any identifiable triggers. For example, if you find yourself out of breath when talking, write this down along with triggers such as stress. Also pay attention to frequency. Does this happen often? Is it getting worse?
Other notable factors that may affect the severity of asthma symptoms include:
- Medical conditions, such as COPD, that can affect breathing
- certain medications
- Improper use of inhalers
- Irritants or allergens
Keeping a diary can help you and your HCP accurately determine the severity of the illness and identify treatment goals as part of a shared decision-making process.
Pulmonologist vs. Allergist for Severe Asthma
People with severe asthma should see a specialist (usually a pulmonologist or allergist) for personalized treatment.
Pulmonologists specialize in the respiratory system and can diagnose, treat, and manage severe asthma that is uncontrolled or has an unknown cause.
Allergists also specialize in treating asthma and asthma triggered by environmental factors.
Severe Asthma Treatment
Severe asthma means dealing with ongoing levels of inflammation in the airways, and treatment usually requires a combination of different medications depending on the type of asthma and what triggers the disease. Treatment may be delivered via inhaler, nebulizer, pills, injection or infusion.
Treatment for severe asthma may include:
- Bronchodilators, which relax the muscles around the airways
- Long-acting beta2 agonists (LABA)
- Long-acting muscarinic antagonist (LAMA)
- Anti-inflammatory medications, including steroids, which help reduce inflammation
- Inhaled corticosteroids (ICS) are medications that can be used long-term to manage symptoms and prevent asthma attacks.
- Oral corticosteroids (OCS), also called oral steroids, are pills or medications in liquid form that reduce swelling and inflammation in the body to treat asthma attacks or treat chronic, severe cases. These medications are prescribed only for short-term use because side effects can be serious.
- Biologics are injectable drugs that work by targeting cells or chemical messengers in the body that cause an inflammatory response in the lungs and airways.
- Other medications that may be used in addition to the above treatment
- Macrolide antibiotics for type 2 inflammation to control the number of white blood cells in the airway to reduce symptoms
- Bronchial thermoplasty is a procedure that uses heat to reduce the amount of smooth muscle tissue, which can reduce airway constriction and reduce seizures.
- Leukotriene regulators, prescription medications that reduce or block the production of inflammatory chemicals called leukotrienes, which cause bronchoconstriction
- Cromolyn sodium, a nasal medication that helps prevent swelling of the nasal air passages, usually caused by allergies
Lifestyle factors also play an important role in the treatment of non-inflammatory severe asthma type 2.
People with type 2 non-inflammatory disease may experience the following changes:
- Reduce exposure to environmental chemicals and allergens
- Use specific products (air purifiers, microfiber dusters, HEPA vacuums, etc.) to keep your home allergen-free and prevent pet dander.
- Quit smoking and avoid secondhand smoke
- maintaining a healthy weight
If you have asthma symptoms, consult your doctor
Severe asthma is a complex disease, but there are treatment options that can help reduce inflammation and improve quality of life. Therefore, if you experience symptoms or think your asthma is getting worse, tell your health care provider right away.
This training material was created with the support of GSK, a member of the HealthyWomen Corporate Advisory Board.
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