- Listen To Your Asthma
- Summary Results
What is Severe Asthma?
Severe Asthma is a respiratory disease that affects the airways and does not respond to commonly prescribed medication for regular asthma. Severe asthma includes the use of oral corticosteroids and an over-reliance on reliever medication to get severe asthma under control. Each individual has different causes and triggers for the symptoms which react differently to their airways.1
Severe Asthma, by the numbers.
passed from asthma-related complications.
2 million sufferers,
7% to 11%
of Severe Asthma in adults among Asian countries.13
Better understand your asthma, so you have better control of your symptoms 6
|Description||Asthma||Uncontrolled Asthma||Difficult-to-treat Asthma||Severe Asthma|
|Daily asthma symptoms and activity limitations|
|Waking up at night due to asthma|
|Daily use of quick-relief medicine|
|Asthma episode requiring oral corticosteroid (OCS)|
|Use of multiple medium to high dose long term controller medicines|
|Biomarkers are positive for type 2 or non-type 2 inflammation|
|Description||Daily asthma symptoms and activity limitations|
|Description||Waking up at night due to asthma|
|Description||Daily use of quick-relief medicine|
|Description||Asthma episode requiring oral corticosteroid (OCS)|
|Description||Use of multiple medium to high dose long term controller medicines|
|Description||Biomarkers are positive for type 2 or non-type 2 inflammation|
Who Gets Severe Asthma?
Severe asthma affects both adults and children. It can develop at any age. Most people who are diagnosed with severe asthma already have an asthma diagnosis: It could have been that their asthma had changed over time, or developed into severe asthma because of hormonal changes, or pneumonia for example. 1
What is it like to have Severe Asthma?
Severe asthma is an unpredictable condition and it is different for everyone. People with severe asthma have more asthma attacks than people with mild or moderate asthma. They are more likely to have to stay in hospital and they are also more likely to be on long term medication.
The symptoms, triggers, responses to medicines, energy levels and impact on daily life are unique to each individual, plus they can change over time.
Having severe asthma can be tough but with the right support and treatment, you can better manage your symptoms.
Severe Asthma Signs and Symptoms6
Individuals who suffer from asthma have an underlying inflammation in the airway that can usually be treated with a combination of quick-relief and long-term controller medicine. However, some individuals do not respond well to inhaled corticosteroids and long-term controller medicine which is a sign of severe asthma.
This inflammation that causes severe asthma may be more difficult to treat, which also requires testing to find the root cause of the inflammation.
Individuals with severe asthma use the highest dose of inhaled corticosteroids with a second oral corticosteroids controller. However, despite using high doses of medication, reducing risks, and following their treatment plan, most of the time their severe asthma remains uncontrolled.
Other signs and symptoms of severe asthma may include:11'12
Shortness of breath that continues to worsen
Pain or tightness in your chest
Wheezing that persists after treatment
Pale skin, lips, or fingernails that may turn blue in colour
Little or no improvement after using your rescue inhaler
Types of Severe Asthma4
Generally, there are two main types of severe asthma which are categorised based on the individual’s response to treatment. Type 2 inflammation and Non-Type 2 inflammation. Type 2 inflammation includes allergic asthma and eosinophilic asthma that respond to treatment with inhaled corticosteroids and IgE (biomarker immunoglobulin E). Non-Type 2 inflammation includes non-eosinophilic asthma which does not respond well to inhaled corticosteroids.
Some specific type of severe asthma includes:
Eosinophilic asthma (E-asthma)
Diagnosing Severe Asthma in 3 steps4
Consult a specialist.
The specialist would review your medical history and current Asthma treatment plan before doing a physical test to access your symptoms.
Determining if it's Severe Asthma.
If it is, the specialist would do additional testing to determine your specific type via biomarkers.
Biomarkers identify the causes of inflammation in your airways by:
Taking your blood sample.
Analysing your mucus sample.
Analysing substances in your breath droplets.
Deciding on a treatment option.
Once your biomarkers have been identified, the specialist would know the type of your Severe Asthma and the different treatment options available.
Treating Severe Asthma
Deciding on a treatment option.5 Once your asthma specialist has determined the type of severe asthma you are suffering from, they can tailor treatment based on your specific type. Below is the chart that describes the biomarkers for severe asthma, the testing method, the type (or phenotype) and the available possible treatment options for targeted therapy.
Once your asthma specialist has determined the type of severe asthma you are suffering from, they can tailor treatment based on your specific type.
Below is the chart that describes the biomarkers for severe asthma, the testing method, the type (or phenotype) and the available possible treatment options for targeted therapy.
|Biomarker||Testing method||Phenotype||Available treatments|
|IgE*||Blood Skin||Allergic (early onset)||Omalizumab|
|Eosinophil||Blood Sputum Breath (FeNO)||Eosinophilic (late-onset) - allergic and non-allergic||Mepolizumab |
|Neutrophil||Sputum||Neutrophilic||Antibiotics Lifestyle Changes|
|Testing method||Blood Skin||Blood Sputum Breath (FeNO)||Sputum|
|Phenotype||Allergic (early onset)||Eosinophilic (late-onset) - allergic and non-allergic||Neutrophilic|
|Available treatments||Omalizumab||Mepolizumab |
|Antibiotics Lifestyle Changes|
For individuals that require a more personalised treatment include:4'5
Macrolide Antibiotics are used by assisting the body in fighting infections.
Oral corticosteroid is mainly used to assist with inflammation. This medication is often combined with quick-relief medicine.
Biologics assist by blocking the response to airway triggers that cause inflammation.
Bronchial Thermoplasty (BT) involves the use of radio frequency energy to apply mild heat to smooth muscle tissue in the airway.
Long term steroids treatment
A daily dose of steroid as an anti-inflammatory medicine to assist in reducing sensitivity in the airways.
Behaviour and Lifestyle Changes
A change to the lifestyle by getting rid of smoking, changing diet, and exercising to reduce obesity and gastroesophageal reflux disease (GERD).
What should I do if I think I have severe asthmaSeek help now
- Asthma UK. What is severe asthma? Available at: https://www.asthma.org.uk/advice/severe-asthma/what-is-severe-asthma/
- Severe Asthma Statistics. LAUNCHING OF THE CLINICAL PRACTICE GUIDELINES ON THE MANAGEMENT OF ASTHMA IN ADULTS: https://www.moh.gov.my/index.php/database_stores/store_view_page/57/1000
- American Lung Association. Asthma Risk Factors: https://www.lung.org/lung-health-diseases/lung-disease-lookup/asthma/asthma-symptoms-causes-risk-factors/asthma-risk-factors
- American Lung Association. Signs and Symptoms, Type of Severe Asthma, Asthma Screening / Diagnosis, Treatment for Severe Asthma: https://www.lung.org/lung-health-diseases/lung-disease-lookup/asthma/learn-about-asthma/severe-asthma
- Asthma UK. How is severe asthma treated?: https://www.asthma.org.uk/advice/severe-asthma/treating-severe-asthma/how-is-severe-asthma-treated/#treatments
- American Lung Association. Do I Have Severe Asthma?: https://www.lung.org/getmedia/1f571956-ee14-4ecc-b608-1f3ab9c15b89/ala-asthma-infographic-2020-v1april-2020.pdf
- Asthma and Allergy Foundation of America. What Causes or Triggers Asthma?: https://www.aafa.org/asthma-triggers-causes/
- Asthma Malaysia. Figures of asthma sufferers: https://www.asthmamalaysia.org/
- NSH UK. Montelukast: https://www.nhs.uk/medicines/montelukast/
- Asthma UK. Taking theophylline for asthma: https://www.asthma.org.uk/advice/inhalers-medicines-treatments/add-on-treatments/theophylline/
- Severe asthma symptoms: https://www.healthline.com/health/severe-asthma?c=1301326415610#symptoms
- Facts and Statistics About Severe Asthma: https://www.healthline.com/health/severe-asthma/facts-statistics-you#symptoms
- Challenges faced in managing adult asthma: A perspective from Asian countries https://onlinelibrary.wiley.com/doi/10.1111/resp.13935