What is Severe asthma?
Severe asthma can greatly impair your quality of life, but newer treatments may help get your symptoms under control.
Around 24 million Americans live with asthma. For some, asthma symptoms such as coughing, wheezing, tightness in the chest, and shortness of breath can be severe, and medication is unable to control them. This is known as severe asthma. Severe asthma has traditionally been hard to define, it’s now considered to be asthma that requires treatment with high-dose inhaled steroids plus a second controller, systemic steroids, or both, in order to prevent asthma from becoming uncontrolled; or asthma that remains uncontrolled despite this therapy.
Severe asthma, however, makes life miserable. You go to the emergency room repeatedly because you can’t breathe. You can’t go to work or school because of your condition, and your quality of life is compromised. Oral and intravenous steroids, which are given by the doctor to treat severe, uncontrolled asthma symptoms. However, the beneficial effects of these steroids aren't necessarily long-term. They generally last 10 days to two weeks, and then the asthma flares again, In some cases, people with severe asthma don’t get better at all. What’s more, repeated use of steroids can cause health complications such as weight gain, bone loss, mood changes, acne, and high blood pressure.
We know that each individual with asthma can have different triggers and a different combination of chemicals in the blood and airways involved, but we don't understand yet why some people get asthma and some people get severe asthma. People with severe asthma have symptoms that are much harder to control because they don't improve with the usual asthma medicines even when they're taken as prescribed.
Why severe asthma Occurs?
Severe asthma attack symptoms
The symptoms of a severe asthma attack may include:
Severe asthma is one of the four categories:
- Some people’s airways may be too inflamed for the usual medicines to work well enough.
- Some people’s inflammation could be caused by chemicals that aren’t blocked or controlled by current medicines and we don’t have the right medicines to control all of the chemicals that cause the inflammation.
- In some people, asthma symptoms are not caused by high levels of allergy-related cells and chemicals, so the usual medicines to tackle these allergic causes don’t work. These people might have 'eosinophilic asthma' where inflammation is triggered by high levels of a particular white blood cell called an eosinophil.
Who Gets Severe Asthma?
You can develop severe asthma at any age. Your asthma can change to become severe over time, or it can be triggered more suddenly by certain factors such as pneumonia or hormonal changes. Most people who are diagnosed with severe asthma already have an asthma diagnosis. Some people are diagnosed right away with severe asthma, but it’s likely that they had asthma for some time before without it being officially diagnosed as severe.
Severe asthma attack symptoms
The symptoms of a severe asthma attack may include:
- Severe shortness of breath where you experience difficulty speaking
- Rapid breathing with the chest or ribs visibly having retractions
- Straining your chest muscles and working hard to breathe
- Nostrils that flare out, moving rapidly as you breathe
- Face, lips, or fingernails becoming pale or blue in colour
- Difficulty inhaling or exhaling fully
- Symptoms not getting better after using a rescue inhaler
- Inability to perform normal activities
- Infants may not recognize their parents or respond to them
Severe asthma is one of the four categories:
- Mild intermittent asthma
- Mild persistent asthma
- Moderate persistent asthma
- Severe persistent asthma
These categories are based on how severe a person’s asthma is, and a person’s asthma severity will often change over time. To find out what category of asthma a patient has, healthcare providers will look at:
- The asthma signs and symptoms the patient has without taking any medications
- The results of the patient’s lung function tests
People with severe asthma generally have symptoms throughout the day on most or all days and they wake up frequently due to their symptoms at night. These symptoms can make daily physical activities very difficult. People with severe asthma also have poor lung functioning that can change a lot from the morning to the afternoon. They often need to use their rescue inhalers several times each day, and they tend to have more frequent asthma attacks that require steroids to treat.
How can severe asthma be treated?
Severe asthma can cause symptoms that are hard to manage, because they may not respond very well to typical asthma medicines. To treat and manage severe asthma, patients will often need more complex treatments that involve higher doses of several different medicines every day. For example, patients might take a combination of:
- Long-term maintenance medicines to reduce inflammation in the airways such as inhaled corticosteroids
- Long-acting and short-acting bronchodilators to relieve symptoms that suddenly get worse
- Anti-inflammatory medicines called leukotriene modifiers
Sometimes, patients with severe asthma may need to take their medications using a special device called a nebulizer.
Physiotherapy can be very helpful for patients living with severe asthma. Specialists called physiotherapists can perform special types of therapies to clear the patient’s airways and coach patients about how to develop good breathing patterns. They can also provide guidance about ways patients with severe asthma can carry out regular exercise routines, even when their physical abilities are limited by their asthma.
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