Severe Asthma is a persistent and complicated respiratory condition that affects a small but considerable proportion of people with Asthma. Unlike mild or moderate Asthma, this form of Asthma does not react well to routine treatments and frequently requires high-dose medications or advanced therapies to control symptoms.
It is characterized by frequent flare-ups, persistent breathing difficulties, and impaired lung function. It has a major impact on the quality of life and can result in several hospitalizations. It is a heterogeneous illness that affects each individual differently, with different causes, underlying inflammatory types, and treatment responses.
Understanding this Asthma form is essential for those affected and their families and communities, as it requires a proactive and specialized approach to management and care. This article will highlight all the necessary aspects of Severe Asthma, ranging from symptoms to management.
Severe Asthma symptoms
Severe Asthma is a subgroup of Asthma defined by chronic symptoms and recurrent flare-ups despite intensive therapy. It is a complicated, multidimensional illness that poses significant challenges in diagnosis, treatment, and long-term control.
The symptoms of this type of Asthma are similar to those of ordinary Asthma, but they are more frequent, intense, and challenging to control, often including:
- Chronic wheezing and shortness of breath
- Chest tightness and discomfort
- Frequent nightly awakenings
- The daily requirement for rescue inhalers
- Frequent episodes of Asthma and hospitalisations
- Inadequate response to traditional Asthma treatments
Types and causes
Severe Asthma is not a single condition but a heterogeneous illness classified into many phenotypes (observable characteristics or traits of a disease) or endotypes (specific biological mechanisms or pathways) depending on underlying inflammatory processes. The main types include:
- Allergic-induced Asthma Allergy-induced Asthma is triggered by allergens and is often characterized by elevated IgE levels.
- Eosinophilic Severe Asthma (e-asthma), marked by persistently high levels of eosinophils (a form of white blood cell) in the blood or airways, regardless of allergic triggers.
- Non-eosinophilic Severe Asthma, a more diverse group, including neutrophilic asthma (where neutrophils are the predominant inflammatory cell), and other forms not driven by significant eosinophilic or allergic inflammation.
The actual causes of Severe Asthma have many aspects and might differ across individuals. While inheritance, a history of allergies, and early life viral respiratory infections are common risk factors in general, this form of Asthma can also be influenced by factors like:
- Poor adherence to medication
- Persistent exposure to environmental triggers (e.g., pollution, occupational sensitizers, tobacco smoke)
- The presence of unmanaged multiple disorders, such as Chronic Rhinosinusitis, Gastroesophageal Reflux Disease (GERD), or Obesity
- A natural resistance to corticosteroid therapy
Airway remodelling, caused by prolonged, uncontrolled inflammation, is also a significant factor in developing permanent airflow restriction, adding to the condition’s severity and resistance.
Gastroesophageal Reflux Disease (GERD) is a severe medical condition where stomach acid frequently travels back into the esophagus, leading to discomfort and symptoms such as heartburn.
Severe Asthma diagnosis
Diagnosing this type of Asthma requires a thorough and systematic assessment to confirm the diagnosis, assess the severity, and uncover any underlying causes of poor management. Diagnosis often includes:
- A complete medical history and physical examination, followed by lung function tests, including spirometry to assess airflow blockage and reversibility.
- Identifying adherence to medicines, inhaler technique, and overcoming persistent environmental triggers.
- Additional tests, such as blood eosinophil counts, Fractional exhaled Nitric Oxide (FeNO), IgE levels, and allergy testing, help determine the Asthma phenotype (e.g., eosinophilic, allergic).
- Identification of associated diseases, such as Chronic Rhinosinusitis, GERD, or obesity, that may worsen Asthma management. According to a study published by the journal Gastroenterology and Hepatology (New York) in 2014, patients with GERD are 1.15 times more prone to have Asthma.
Treating Severe Asthma
Managing Severe Asthma requires a multidisciplinary and individualized approach, often involving pharmacological and non-pharmacological methods.
Pharmacological therapy
First-line therapy often consists of Asthma medicines like high-dose Inhaled Corticosteroids (ICS) paired with Long-acting Beta Agonists (LABAs), which may be supplemented with additional medications, such as Leukotriene Receptor Antagonists (LAMAs).
However, many patients with this form of Asthma remain symptomatic despite these medications. Biologic therapies, such as Omalizumab (anti-IgE), Mepolizumab, Benralizumab, or Dupilumab, are used in such cases. These therapies target specific pathways of inflammation, like eosinophil count, IgE levels, or FeNO.
As per a review published by the Journal of Personalized Medicine in 2022, Omalizumab is effective in overcoming the symptoms associated with the condition.
Short courses of oral corticosteroids may be required during flare-ups, but prolonged usage is discouraged due to side effects.
Non-pharmacological approach
Besides medications, the following strategies can help reduce the flare-ups:
- Pulmonary treatment to reduce symptoms
- Education about inhaler technique and adherence
- Environmental control (removal of triggers)
- Management of associated diseases
- Regular evaluation of Asthma control and risk
- Stepwise adjustment of therapy based on control and side effects
Conclusion
Severe Asthma is a serious, long-term, rare illness that can significantly disrupt a person’s everyday life. It is more difficult to control than common Asthma and may not react well to traditional therapies. People with this condition may require more potent medications, frequent medical visits, and specialised care.
However, many people may now control their symptoms more successfully because of improved medications like biologic medicines and a better understanding of their individual Asthma type. It is also essential to prevent triggers, address underlying health issues, and utilize inhalers carefully.
Support from doctors, caregivers, and Asthma experts is essential to improving the quality of life. Although living with the illness can be difficult, the correct care and treatment plan can assist patients in breathing more easily and living more comfortably.
Frequently Asked Questions
Is Severe Asthma a disability?
Yes. Severe Asthma might be considered a disability if it severely impairs a person’s ability to carry out everyday tasks or jobs. In many countries, people with severe, uncontrolled Asthma are eligible for disability benefits or workplace accommodations.
Can Severe Asthma lead to COPD?
No. Severe Asthma does not directly cause Chronic Obstructive Pulmonary Disease (COPD), but long-term, poorly managed Asthma can result in persistent airway damage and airflow restriction, which may mimic COPD. Asthma-COPD overlap (ACO) occurs when some people get symptoms from both conditions.
How to exercise with Severe Asthma?
Exercise with the condition by engaging in low-impact activities like walking, swimming, or yoga. Warm up before and cool down after a workout. Use prescription inhalers as required, minimize triggers, and work with your doctor to develop a safe workout plan.
Is Severe Asthma an autoimmune disease?
No, this form of Asthma is not an autoimmune disorder. It is a chronic inflammatory illness of the airways that is commonly triggered by allergens or environmental factors. Unlike autoimmune diseases, it does not include the immune system attacking the body’s own tissues.
Is Symbicort for Severe Asthma safe?
Yes, Symbicort can be a safe and effective treatment for Severe Asthma when prescribed by a doctor. It contains a corticosteroid to reduce airway inflammation and a long-acting bronchodilator to help with breathing. Ongoing medical supervision is essential to manage any side effects and ensure the treatment works well.
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