What is severe asthma and how do you know if you have it?
Peer reviewed by Dr Krishna Vakharia, MRCGPLast updated by Amberley DavisLast updated 18 Apr 2023
Severe asthma has a huge impact on people's daily lives, with symptoms often lasting for hours and sometimes days. There can be serious consequences if the condition is not properly controlled but following your doctor's treatment advice and staying fit and healthy can dramatically improve your quality of life.
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GB-37402 DOP 04-2023
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What is classed as severe asthma?
Less than 10% of people with asthma are diagnosed as having severe asthma. More unpredictable and harder to manage than mild and moderate asthma, severe asthma is the most debilitating form of this condition.
Those with mild, moderate, or severe asthma may share the same common asthma symptoms of breathlessness, wheezing, and coughing, but there are a few key differences with severe asthma:
Symptoms are much worse and can last much longer.
Symptoms often occur daily and have a huge effect on people's lives.
Symptoms don't always respond well to standard asthma treatments and medications.
"Individuals with severe asthma will experience continuous symptoms daily, despite taking their asthma medication," says Margaret Kelman, specialist allergy nurse at Allergy UK. "They will experience frequent asthma attacks and often be admitted to hospital for their asthma."
While this can sound scary, there are specific asthma treatments and lifestyle changes that can make a significant, positive difference in people's lives. Getting a diagnosis of severe asthma is an important first step in creating an asthma action plan that can help you to gain better control of your condition.
Severe asthma fact sheet
What causes severe asthma attacks?
People who have asthma are sensitive to their triggers - such as stress, smoke fumes, or pollen - which cause their airways to narrow as part of an immune response. It is not understood why some people's reactions are more severe than those experienced by others.
"In severe asthma the immune system continues to try to defend itself and produces lots of cell and chemical messengers that produce the common symptoms we recognise, such as tight chest, breathing difficulties, excess mucus production, and inflammation," Kelman explains.
Is severe asthma COPD?
It's easy to confuse severe asthma and COPD (chronic obstructive pulmonary disease). Both are lung conditions that can lead to flare-ups of shortness of breath, wheezing, and coughing. However, with asthma, your airways change between being relaxed and being narrowed, depending on when symptoms are triggered. In contrast, with COPD your airways are permanently narrowed.
What are serious severe asthma complications?
Severe asthma can cause serious damage, but if you follow your doctor's advice and manage asthma with a treatment plan, you significantly reduce the risk of the following:
Airway damage - airway remodelling can happen over time as your airways become more inflamed, scarred, and thicker. This means in turn they become narrower which leads to the worsening of your symptoms. By following treatment advice, you can help prevent and even reverse this effect.
Lung damage - asthma can increase the risk of atelectasis, where one or more lobes (sections) of the lung collapse because of blockage inside the airways or pressure outside the lungs. It can also lead to pneumothorax - the build-up of gas or air between the inside of your chest wall and outside of your lung, the pressure of which can cause your lung to collapse. Both are life-threatening and require emergency treatment.
Respiratory failure - a prolonged, severe asthma attack could mean that not enough oxygen travels into your blood from your lungs. If emergency help isn't reached in time, this could lead to fatality.
Does severe asthma shorten life expectancy?
Sadly, generally speaking, people with long-term (chronic) severe asthma have a reduced life expectancy. "Severe asthma is difficult to control and is the most dangerous and life-threatening form of asthma," says Kelman.
Yet, it is important to recognise that many of the asthma-related deaths that occur happen when severe asthma goes unrecognised and is poorly controlled.
How severe is my asthma?
You may experience regular asthma symptoms, but this doesn't necessarily mean that you have severe asthma. A good place to start is to ask yourself if your asthma is having a major impact on your day-to-day life - is it hindering your ability to carry out everyday tasks? Is it affecting your work and social life? Have you had to adapt your life to live within your abilities?
During a severe asthma attack:
You find it so difficult to breathe that talking or walking are hard or impossible.
Your face, lips, or fingernails may turn blue.
You may become agitated or confused.
Your inhaler doesn't provide effective, quick relief - it may not work at all, or may provide only very brief relief.
In extreme cases, your usual symptoms of coughing or wheezing may not be severe (as you may not be taking in enough air to produce these sounds).
These symptoms could last for hours and sometimes days. If you have an asthma attack that looks like this, you should go to the hospital immediately for emergency treatment.
Whether you are undiagnosed, or diagnosed with mild or moderate asthma, if you believe that your asthma symptoms are severe you should visit your doctor. They will be able to assess, diagnose, and form an asthma action plan tailored to your severity level.
How is severe asthma treated and managed?
Despite the risks, there is a history of people not following specialist severe asthma treatment advice properly. Trying to get severe asthma under control can be disheartening, and it can take time to find the right treatment combination for you.
Patient picks for Asthma
But remember, with the right treatment plan in place, it's possible to manage asthma and improve your quality of life significantly.
Take care of yourself and control of your asthma by:
Taking your medication as prescribed. This will include learning the correct inhaler technique and may also include other medications as recommended.
Attending your hospital appointments if you're referred.
In the last few years, several new treatments have become available for people with severe asthma. These include medicines given by injection, antibody therapy, or bronchial thermoplasty. However, they are usually only available through specialist clinics.
Following your asthma action plan
This is a tailored treatment plan agreed with your healthcare team which includes both asthma medications and non-medicinal methods of management.
Attending regular asthma reviews
This will allow your healthcare team to reassess your severity and adjust your asthma action plan if needed - for example, identifying new treatment options and increasing asthma medications to a higher dose if required.
Avoiding your asthma triggers where possible
Everyone's triggers are different, but this might include staying inside when the pollen count is high, or having your house assessed for house mites and mould volume.
Making sensible lifestyle adjustments
Being fit and healthy can dramatically improve your asthma. You should refrain from smoking, eat healthily, exercise regularly, and if you're overweight or obese aim to reach a healthy weight.
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Penny's story
Penny's experience is an inspiring example of the benefits of exercise and diet. However, it's important to note that everyone is different and not every person with severe asthma will see the same results. You should always follow the advice of your healthcare professional.
How I used fitness to reduce my symptoms after a collapsed lung
At the age of 26, fitness and nutrition expert Penny Weston suffered a collapsed lung due to suffering from severe and chronic asthma from a young age.
"It was incredibly scary to be totally out of breath whilst lying down, and a huge wake-up call for me. I was terrified!" she says. "I had to rest on the sofa and not move for days."
Following this terrifying ordeal, Penny focused on improving her health through exercise, diet, and nutrition. Now, she is the director of award-winning Moddershall Oaks Country Spa Retreat and founder of MADE wellness centre.
"I started getting into fitness to try to help my lungs and asthma. Initially, I went to circuit training classes with a friend. The stop-start nature of circuits, and later HIIT training, helped to strengthen my lungs.
"As time went on, I became fitter and more confident. I also realised that I really liked what fitness and healthy food had done to my body and my life, and I saw an opportunity to help other people enrich their lives."
Penny now no longer needs to take the steroid tablets that she was told she'd be on forever. "I went to the doctor after about three or four years of training and while they said, "you can't cure asthma", they confirmed I had gone from a 9/10 severity to a 1/10. I had reduced my asthma to the least severe it could be.
"Now day-to-day, asthma doesn't affect me, but I am prone to chest infections, so I have a reliever inhaler. If I get a cold or a cough, my chest can get quite tight, and I have to take antibiotics, so that's when the asthma flares up.
"I used to avoid being active, but it's increasing my fitness that contributed to helping my asthma."
How to exercise with severe asthma
"If you're worried that doing any physical exercise will set off your asthma, it's a good idea to speak with your GP or nurse and agree a plan of action," says Kelman. "When exercising, make sure your reliever medication is easily accessible, follow your personal asthma action plan to identify when your asthma is not well managed, and get to know your triggers so that you can avoid them where possible."
Article History
The information on this page is written and peer reviewed by qualified clinicians.
18 Apr 2023 | Latest version
18 Apr 2023 | Originally published
Authored by:
Amberley Davis
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