If someone experiences asthma symptoms more than twice a week, their asthma is termed “persistent.” And among those with persistent asthma, doctors further categorize the condition as mild, intermediate, or severe. “The symptoms of severe asthma are similar to those of mild asthma, they’re just more frequent and more severe, and require more medications to keep them under control,” says Emily Pennington, MD, a pulmonologist and asthma specialist at the Cleveland Clinic in Ohio. By definition, people with severe asthma require either a high-dose inhaled corticosteroid, plus a second form of medication; or they require systemic (oral) corticosteroids to manage their symptoms. The term “severe asthma” also applies to people whose symptoms don’t respond well to these forms of treatment. This type of severe asthma is also sometimes called “uncontrolled asthma.” (1) RELATED: Learn More About Other Types of Asthma During these kinds of severe asthma attacks, a person may experience: (2,3)
Trouble breathingWheezingTrouble speaking due to shortness of breathCoughingChest tightness
For other people with severe asthma, an attack may produce symptoms that require emergency medical attention. These include: (4)
Difficult and rapid breathingVery pale or blue lips, fingers, or skin coloringRapid movement of nostrilsRibs and stomach sucking in and pushing out rapidly and noticeablyA chest that expands while taking a breath, but doesn’t deflate
RELATED: Learn More About What a Severe Asthma Attack Looks Like
The lung’s airways are so inflamed that normal medications don’t work.The chemical molecules or other asthma triggers that cause a person’s symptoms aren’t effectively blocked by current medications.A person has a mild and undiagnosed form of asthma that gets worse over time due to lack of treatment.
RELATED: What Are the Signs and Symptoms of Asthma? People with severe asthma are also much more likely to experience bluish lips or skin, extreme breathing difficulties, or other symptoms that require emergency medical attention. (4) Along with assessing symptoms and conducting a physical exam, most doctors will perform some kind of “objective” lung-function test in order to diagnose severe asthma. This test could take several forms, including: (2,6,7)
Spirometry, which measures how much air you can inhale and exhalePeak air flow, which measures how well air flows in and out of the lungs
Results from these tests can help your doctor determine if your symptoms should be categorized as severe asthma. RELATED: What You Need to Know About Asthma Treatment and How to Use an Inhaler Inhaled corticosteroids work by calming lung inflammation. Oral corticosteroids do the same thing, but they can sometimes work better than inhaled corticosteroids — especially if a person isn’t responding well to inhaled medications. But these corticosteroids can come with side effects, including: (9)
InsomniaWeight gainMood swingsHigh blood pressureBrittle bones and bone fracturesElevated infection risks
There is some evidence linking air pollution to moderate and severe asthma. It’s possible that people with asthma who are able to avoid air pollution — like the kind caused by heavy vehicle traffic — may avoid symptoms of severe asthma, according to the Asthma and Allergy Foundation of America. (10) It’s also possible that taking care to manage mild asthma symptoms could prevent your condition from growing more severe. But as of right now, there’s no known effective way to protect yourself from severe asthma. Dr. Pennington also says that, for reasons that aren’t well understood, severe asthma can become milder in some people as time passes. But there’s no well-defined recovery pathway for people with severe asthma. Every individual with this type of asthma is different.
Is Severe Asthma a Disability?
In some cases, yes, severe asthma is a disability. Specifically, if your severe asthma causes frequent hospital visits even when you follow your doctor’s treatment plan, you may qualify for disability benefits. (12)
Can Severe Asthma Cause COPD and Other Complications?
Severe asthma and chronic obstructive pulmonary disease (COPD) are two different conditions, and one doesn’t cause the other. But in some people, these conditions overlap. This is known as asthma-COPD overlap syndrome. (13) While severe asthma isn’t thought to cause COPD, it can lead to other complications. These include:
Poor sleepWeight gainAirway remodeling, which refers to the harmful scarring or other irreversible changes to the lung’s airwaysAnxiety or depressionIncreased risk for reflux (GERD) or obstructive sleep apnea
Can a Severe Asthma Attack Cause Permanent Damage?
Over time, asthma-related inflammation can cause permanent lung damage. This damage includes airway remodeling, which is a kind of lung scarring that makes breathing more difficult and medications less effective. Airway remodeling is a risk for people with severe asthma, and attacks can contribute to this type of damage. (14)
