Asthma is an inflammatory lung disease that can lead to mild to severe symptoms. In most cases, you can control your asthma by avoiding triggers, taking daily medications, and using other treatment options.

But if your asthma doesn’t stay under control with any type of treatment, this means your asthma is severe. Severe asthma may also mean you need high doses of inhaled corticosteroids or long-term oral corticosteroids in addition to other daily medications.

Some doctors have differing opinions on the definition of severe asthma. In 2010, the World Health Organization put severe asthma into three different categories:

  • untreated asthma
  • difficult-to-treat asthma
  • therapy-resistant asthma

While severe asthma can be difficult to treat, it’s still possible to get it under control. Keep reading to learn the symptoms of severe asthma, signs of an attack, and treatments to manage your condition.

The symptoms of severe asthma are similar to the symptoms of mild to moderate asthma. But severe asthma symptoms tend to be more intense, potentially life threatening, and difficult to control with asthma treatments.

Signs and symptoms of severe asthma may include:

  • shortness of breath that continues to worsen
  • pain or tightness in your chest
  • cough that may be dry or with excess mucus
  • wheezing that persists after treatment

Since severe asthma can sometimes be life threatening, make sure you know when to seek emergency medical care. If you have shortness of breath that occurs when doing simple physical activities or quickly gets worse, call 911 or go to a hospital.

If a quick-relief inhaler doesn’t help either, you may need emergency treatment.

If you have severe asthma, your symptoms will tend to be severe, persistent, and difficult to manage, according to categories in the guidelines from the Global Initiative for Asthma (GINA) and National Heart, Lung, and Blood Institute.

Severe asthma either doesn’t respond to treatments and medications at all or is very difficult to treat. This lack of response to medications is known as therapy-resistant asthma. It may be because your asthma has become resistant to corticosteroids or other medications used to treat asthma.

A doctor might give a diagnosis of severe asthma if you:

  • have needed treatment with high dose inhaled steroids and a long-acting beta-agonist (LABA) or leukotriene modifier or theophylline in the past year
  • have needed systemic glucocorticoids for half the year or more to manage symptoms
  • have no other conditions or factors that could explain the symptoms

If your asthma isn’t responding to medications, see your doctor for a diagnosis and alternative treatment options. They will check to see if you have other conditions that may be mimicking asthma, such as angina and heart failure. They will also examine you for complications of severe asthma, such as chronic infections and allergic bronchopulmonary aspergillosis.

If you have severe asthma, your doctor will work with you to develop a treatment plan. This may include medications and lifestyle changes, along with natural treatments.

Medications

Medications and treatments that you can try for severe asthma may include:

  • corticosteroid injections
  • higher doses of inhaled corticosteroids
  • using inhaled corticosteroids more frequently
  • continuous inhaled nebulizer
  • ipratropium bromide aerosols
  • long-acting beta-agonists (LABAs)
  • montelukast
  • theophylline
  • oral corticosteroids
  • biologics
  • oxygen therapy

The medications listed above may be used alone or in combination to try to get your severe asthma under control.

Lifestyle measures

The following lifestyle measures may help in the treatment of your severe asthma:

  • When possible, remove or avoid any allergens or exposure to environmental irritants like chemicals.
  • If you have obesity, manage your weight under the care of your doctor.
  • Avoid known triggers whenever possible.
  • Avoid smoking and secondhand smoke.

Natural treatments

While natural treatments shouldn’t replace your asthma medications, you may benefit from trying some of these in addition to your prescribed treatments.

Examples of natural treatments include:

  • breathing exercises, which may help reduce the amount of medication you need
  • herbal remedies, including black seed, choline, and caffeine
  • yoga and mindfulness, which can decrease stress, an asthma trigger

More research is needed on many alternative treatments and their effects on severe asthma symptoms. Discuss any herbs or supplements you’re thinking of taking with your doctor before starting them.

The symptoms of a severe asthma attack can include:

  • severe shortness of breath where you have trouble speaking
  • rapid breathing where your chest or ribs visibly have 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 color
  • difficulty inhaling or exhaling fully
  • symptoms not getting better after using a rescue inhaler
  • inability to perform usual activities
  • infants unable to recognize their parents or respond to them

If you or your child is having symptoms of a severe asthma attack, you should call 911 for immediate medical attention. Severe asthma attacks can lead to respiratory failure, which is a life threatening condition.

Severe asthma usually requires lifelong treatment and medical management. Since severe asthma is difficult to treat, the length of recovery time from a severe asthma attack will vary based on your individual situation and the length of time it takes to get the severe asthma attack under control.

Severe asthma can sometimes lead to lung damage, which may be permanent and may require additional treatment. That’s why it’s so important to get help as soon as possible during a severe asthma attack.

To speed up your recovery, try to rest as much as you can. You may feel physically and emotionally exhausted, so take a day to relax and don’t overdo things.

Also, see your doctor as soon as possible so they can review your symptoms and medications and adjust as needed. They can give you tips for recovery and update your asthma action plan to prevent another attack.

The best way to prevent severe asthma and severe asthma attacks is to follow the treatment plan provided by your doctor. If your current one isn’t working, work with them to adjust it.

Here are some other ways you can prevent severe asthma and severe asthma attacks:

  • Track your symptoms and use medications regularly to manage them.
  • If you smoke, get help quitting.
  • Get routine vaccinations for the flu, whooping cough, and pneumonia.
  • Let your doctor know if you notice your treatment plan and medications stop working.
  • Reduce your exposure to any allergens that may trigger your asthma.
  • Wear a face mask when you exercise in cold weather.
  • If your job involves handling chemicals, take proper precautions.
  • Avoid going outside on days with poor air quality.
  • Talk with your doctor about a weight management plan if necessary.
  • Use your rescue inhaler as instructed at the first signs of an asthma attack.
  • Use your daily medications as directed, which includes allergy treatments and other medications.

Ask your doctor to help you create an asthma action plan. This action plan will outline the steps you need to take in case of an asthma attack. You should share this plan with your family, friends, and co-workers. By sharing your plan, they’ll be able to help you if you experience an attack.

What happens if you have severe asthma?

With severe asthma, usual medication will not bring relief. The symptoms will also be more extreme and last longer than they usually do with asthma. You will need to work closely with a doctor on a treatment plan, and you may need to try several combinations before finding one that works for you.

How do I know if I have severe asthma?

If you have asthma that does not respond to typical asthma therapy, you may have severe asthma.

Can severe asthma go away?

Severe asthma is a long-term condition, and some people have it for life.

However, around half of children with asthma “grow out of” it by the time they reach adulthood. As their bodies develop, their airways mature and respond more effectively to airway inflammation and irritants. Their symptoms can decrease and sometimes disappear completely by the time they start school, especially if they only wheezed during viral infections and there’s no family history of allergic reactions. However, some outgrow it only for it to return when they’re older.

The goal of treatment is to get your asthma under control, so it’s important to consistently adhere to your treatments and lifestyle.

If you feel that your treatments aren’t working as they should be, discuss your options with your doctor. Regularly seeing your doctor will ensure that you’re effectively managing your severe asthma.