What to Know About Treating Severe Asthma

Treating severe asthma can take trial and error but may include options like biologic medications and oral corticosteroids. Your medical team will work with you to find the best treatment for your condition.

Managing severe asthma typically requires high doses of medication. In some cases, severe asthma may not respond well to typical asthma treatments.

However, there are treatment approaches that can help relieve asthma symptoms and improve your quality of life. The best options may vary per person and can depend on your symptoms and asthma type.

Read on to learn more about what to expect when treating severe asthma, including its types, treatment options, and outlook.

Medical professionals define severe asthma as asthma that needs medium or high doses of inhaled corticosteroid medications as well as other medications.

Some people have severe persistent asthma, which is asthma that:

• may require you to use your rescue medications several times a day
• can cause more frequent and severe asthma attacks
• causes symptoms to occur throughout the day
• leads to sleep time symptoms 5 days a week or more in adults and children, or sleep time symptoms more than 1 day a week in children ages 4 years and younger
• limits your daily activities
• decreases lung function, including:
  • a forced expiratory volume (FEV1) rate of less than 60%
  • a forced vital capacity (FEV1/FVC) rate of less than 75%

Contact your doctor if you have any symptoms of severe asthma, notice your asthma worsening, or feel like your current treatment isn’t helping.

Learn more about diagnosing asthma and asthma severity classifications.

Experts can split severe asthma into two main categories, depending on your asthma’s reaction to treatment:

• Type 2 inflammation: This includes allergic and eosinophilic asthma. Allergic asthma is triggered by allergens, such as dust, pollen, and pet dander. Eosinophilic asthma is when high levels of white blood cells called eosinophils cause airway inflammation. These types of asthma may respond better to treatment with inhaled corticosteroids and biologic medications.
• Non-type 2 inflammation: This includes non-eosinophilic asthma, which is when people have little to no eosinophils. Non-eosinophilic asthma tends not to respond well to inhaled corticosteroids.

Read more about allergic and eosinophilic asthma.

Treatments for severe asthma can include:

• Macrolide antibiotics: These antibiotics can help reduce infection and inflammation. However, they can lead to antibiotic resistance, so doctors avoid prescribing them for long-term use.
• Oral corticosteroids: Corticosteroids can help reduce inflammation. Doctors may recommend them alongside inhaled corticosteroids.
• Biologics: Biologic medications help block cell responses that lead to airway inflammation. You can take them via injection or an infusion with an intravenous (IV) line every 2 to 8 weeks.
• Bronchial thermoplasty: Bronchial thermoplasty is a procedure that applies heat to targeted areas of your airways, removing excess muscle tissue that may have built up due to asthma and other factors. This can help unblock your airways.
• Lifestyle approaches: Self-care techniques can also help severe asthma. Your medical team may recommend:
  • keeping a symptom and activity diary to identify and avoid your asthma triggers
  • avoiding smoking
  • treating gastroesophageal reflux disease (GERD) if you have it, to reduce inflammation
  • maintaining a moderate weight

Not all treatment options will be safe or effective for everyone with asthma. It may take trial and error or time for you to find a treatment plan that works for you.

Your medical team will tailor their treatment recommendations to your condition and needs.

Read more about biologic medications and other treatment options for severe asthma.

The outlook of severe asthma can vary between people.

Generally, while treatments can be effective and improve your symptoms or quality of life, they cannot cure asthma.

In serious cases, severe asthma can cause other health complications or can be fatal, especially if left untreated.

You will likely need to use daily treatment and prevention approaches long term to protect your health.

If you have questions about managing severe asthma or asthma complications, talk with your medical team for tailored advice. Also talk with a doctor if you need support or notice mental health symptoms while managing severe asthma.

Find out more about asthma outlook and possible complications of severe asthma.

If you go to the hospital for severe asthma symptoms or an asthma attack, the medical team may provide emergency care such as:

• fluids through an IV line
• medications for asthma relief, such as corticosteroids and bronchodilators
• anticholinergic medications to reduce muscle tightening in your airways
• oxygen therapy
• ventilation, whereby a machine helps you breathe

Doctors may decide to admit you as an inpatient if you need further monitoring or treatment.

Learn about hospital care for asthma, including treatment and when to call 911.

Also, find out how to recover from a severe asthma attack.

Treatment options for severe asthma can include:

• oral corticosteroids
• biologic medications
• bronchial thermoplasty
• self-care

Your medical team will work with you to find the best option for you.

While treatment can help improve severe asthma symptoms, your condition will likely require long-term care to help reduce the risk of asthma attacks and complications.

Talk with a doctor if you have any questions about severe asthma or feel your current treatment isn’t helping.