How do I know if my asthma is severe?

If you have many asthma symptoms and frequent attacks, you might wonder if there is something wrong with your asthma. Indeed, your asthma might be “severe asthma”.

Severe asthma is asthma that remains uncontrolled despite optimised treatment with high dose inhaled corticosteroids-long-acting beta agonists (ICS-LABA), or that requires high dose ICS-LABA to prevent it from becoming uncontrolled. This means that the symptoms are harder to control with usual asthma medicines. In this case you should see a specialist to find the medicines and doses that work best for you. Optimised treatment includes good adherence to these medications, correct inhaler technique, and treatment of contributory factors and other conditions that can influence asthma.

In many cases, asthma may be uncontrolled due to difficulties in following the treatment, for instance in case of an incorrect inhaler technique, poor adherence to treatment, over-use of short-acting beta2-agonist bronchodilators (SABA), and persistent exposure to risk factors. This is why it is very important to discuss with healthcare providers about how to improve adherence to treatment and your inhaler technique.

Novel treatments, known as “biologicals”, have been developed for severe asthma and are already available in some countries. Your doctor can advise if these treatments may be suitable for you.

Severe asthma and quality of life

Severe asthma may interfere with family, social and working life, limit career choices and leisure, and affect emotional and mental health. Patients with severe asthma may feel alone and misunderstood, because their life differs greatly from that of most people with asthma. If you feel that way, do not hesitate to seek emotional support .

About asthma treatments

Maintenance medications

Inhaled corticosteroids (ICS): Anti-inflammatory drugs used for long-term control of. These drugs reduce swelling and tightening in your airways, control symptoms, improve lung function, and reduce the risk of asthma severe attacks and of asthma deaths. They will start to improve your asthma within hours or days, and your asthma may continue to improve for several months after you start taking them.

ICS in combination with Long-acting beta agonists (LABA): Using a combination of ICS with a long-acting bronchodilator helps to reduce asthma symptoms and reduces the risk of attacks better than a higher dose of ICS. LABAs must be taken only in combination with an ICS, since if they are used on their own, they can increase the risk of severe asthma attacks. There are different types of ICS-LABA combinations: ICS combined with formoterol, and ICS combined with other LABAs such as with salmeterol or vilanterol.

Reliever medications

SABA (Short-acting beta-agonist): Reliever medications that open the lungs by relaxing airway muscles. They can relieve asthma symptoms temporarily. They begin working within minutes and are effective for four to six hours. They are not controller medications and they do not protect you from having another asthma attack. In fact, frequent use of SABAs may increase the risk of severe attacks and even death.

Low-dose combination ICS-formoterol: This is a combination of ICS and formoterol, a LABA with fast onset of action. It is an anti-inflammatory reliever inhaler that relieves symptoms as quickly (or almost as quickly) as a SABA, and it also provides a low-dose of anti-inflammatory medication to treat airway inflammation.

In people with mild asthma, low-dose ICS-formoterol can be used as-needed on its own, without any regular daily controller treatment. It reduces the risk of having severe attacks better than a SABA reliever alone. This as-needed-only treatment is approved for mild asthma in many (but not all) countries.

For patients with moderate or severe asthma, ICS-formoterol is taken both as the person’s regular daily maintenance treatment and also as-needed for symptom relief. This procedure, which is called Maintenance and Reliever Therapy (MART), reduces the risk of having severe attacks compared with using a SABA reliever. has long been approved for the treatment of asthma in many countries for many years.

For patients prescribed combination ICS-formoterol, it can also be used before exercise or before allergen exposure.

All adults, adolescents and children aged six years and older should be prescribed an ICS-containing inhaler, to reduce the risk of severe attacks. Asthma should not be treated with a SABA reliever alone, except in some young children.

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