Asthma is a chronic inflammatory disease that affects your airways and interferes with your ability to breathe. Uncontrolled asthma can lead to the airways becoming swollen and increasingly narrow or producing excessive mucus, making it difficult for air to move in and out.
Common symptoms of asthma include coughing, wheezing, tightness around the chest, and breathlessness that alters in severity with time and with exposure to specific irritants/allergens. While asthma attacks can be serious, most symptoms can be managed by consulting a doctor who might guide a patient to quick-relief medications such as bronchodilators that open narrowed or swollen airways. In some cases, the doctor may also add anti-allergic medicines.
For long-term management of the condition, controller or preventive medications containing inhaled corticosteroids are given by the clinician to manage asthma on a day-to-day basis.
What is severe asthma?
Severe asthma is when the disease is uncontrolled in spite of the highest possible dose of inhalational therapy after addressing all the modifiable factors interfering with optimal control.
Some factors that help the doctor differentiate asthma from severe asthma are:
- Are you taking your prescribed medications regularly? Are you at maximal doses of your inhaled therapy?
- Are you using your inhaler correctly?
- Have you been avoiding triggers, such as dust, pollen, and animal dander?
- Are all your coexisting conditions e.g. acid reflux, allergies, etc. being appropriately managed?
If you continue to develop symptoms in spite of answering ‘yes’ to all of the above questions, it indicates severe asthma. Simply put, severe asthma is asthma that does not respond to standard forms of treatment. Nearly 5% of Indian patients with asthma suffer from severe asthma. Patients with severe asthma often suffer from severe flare-ups (called exacerbations), need to visit the emergency room or require hospitalisation to manage their condition.
How can you differentiate severe asthma from asthma?
Symptoms of severe asthma are similar to that of asthma but are more intense and last for a longer period of time. Overall, the symptoms affect daily functioning and reduce one’s ability to work, decreasing productivity.
Symptoms of a sudden severe asthma attack constitute a medical emergency and include:
- A bluish tinge to your lips, face or fingernails
- Need to stand up or sit to breathe more easily
- Confusion or agitation
- Inability to speak in full sentences
- Breathlessness and inability to inhale/exhale completely
- Rapid breathing
- Absence of relief from symptoms even after using a reliever inhaler
All patients with severe asthma are not the same
Why are some people more prone to severe asthma than others? Though the exact reasons are not known, older people and those with impaired lung function have greater chances of developing it. Sometimes asthma becomes more severe after a respiratory infection.
Research has shown that though the symptoms of severe asthma may appear similar across patients, the underlying mechanisms are different. Depending upon the patterns of inflammation and the presence of various immune cell types, inflammation in severe asthma is mainly divided into three types—allergic, eosinophilic, or non-eosinophilic. Eosinophilic asthma is an adult-onset condition, whereas allergic asthma normally begins in childhood.
Along with the patient’s symptoms and their frequency, a chest X-ray with certain lung function tests such as spirometry, lung volume assessment and fraction of exhaled nitric oxide (FeNo) help the clinician in confirming the diagnosis of severe asthma.
How can severe asthma be treated?
The goal of treatment is to achieve good control of symptoms, reduce flare-ups and improve the patient’s quality of life. Since patients with severe asthma are already on maximum doses of inhaler therapy, they are normally initiated on oral steroids with/without anti-allergic medications to curtail the symptoms. However, steroid use should be monitored carefully due to side effects such as increased susceptibility to infections.
Once the root cause of severe asthma is determined, targeted treatments such as biologics can be added to the therapy to decrease the frequency of flare-ups and reduce the need for oral steroids. Biologics are injections that need to be taken approximately once a month and provide relief from persistent symptoms.
A patient should consult their doctor to garner maximum benefit from both conventional and targeted treatments. If you are persistently troubled by symptoms of asthma, do not ignore them and reach out to your doctor to help manage your condition better.
The author is Director and Unit Head Pulmonology, Fortis Escorts Hospital, Faridabad
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