A man is using an asthma inhaler
Severe asthma is defined as asthma symptoms that persist and are not controlled by standard medications and avoiding triggers.

What Is Severe Asthma?

The Asthma and Allergy Foundation of American estimates that about 25 million people in the United States have asthma. If you are one of the millions of people will asthma, you probably know it can vary in severity.

The condition can vary from mild to severe. Severe asthma is defined as asthma symptoms that persist and are not controlled by standard medications and avoiding triggers.

Severe asthma not only involves symptoms uncontrolled by medication. It also includes frequent exacerbations. People with this type of asthma are at an increased risk of a fatal asthma attack.

Symptoms of Severe Asthma

Symptoms of severe asthma include often include the following:

  • Severe chest tightness
  • Wheezing that is not improved after breathing treatments
  • Extreme shortness of breath that interferes with activity
  • Coughing that may lead to bronchospasm
  • Rapid breathing
  • Retractions, which involves the ribs moving inward as you breathe
  • Working hard to breathe and straining your chest and shoulder muscles
  • Blueish lips or fingernails

How Is Severe Asthma Diagnosed?

A diagnosis of severe asthma is made after a review of symptoms, their frequency, and a physical exam. A chest x-ray or chest CT scan may also be useful to check for inflammation of the lungs and rule out other conditions, such as pneumonia. If you have this type of asthma, your doctor may also order a pulmonary function test to determine if your lung function has decreased.

Differences Between Moderate/Mild Asthma and Severe Asthma

Symptoms of asthma, such as wheezing, coughing, and chest tightness may occur with moderate or mild asthma. But there are differences between moderate or mild asthma and severe asthma.

People that have mild or moderate asthma may not have symptoms very often. Certain triggers may lead to a flare-up of symptoms. When symptoms do occur, taking prescribed medication, such as bronchodilators helps. Daily preventative medications including steroids or long-acting bronchodilators often keep symptoms at bay.

But people with severe asthma may avoid triggers and take their preventative medications and still get symptoms. When symptoms develop, standard treatment, such as inhalers, may not help much. Even if you do all the right things and follow your asthma action plan, symptoms may persist if you have severe asthma.

The exact reason some people develop severe asthma is not completely known. One theory is that some individuals develop airway inflammation that is so severe, standard medications, such as steroids, do not work well.

It’s also possible that severe asthma may be caused by inflammation triggered by eosinophils, which are a type of white blood cell. Many standard asthma medications do not target eosinophils so they may not work for people that have eosinophilic asthma.

Severe Asthma Treatment

It is vital to treat this condition. Not only does this type of asthma make you miserable, but it also puts you at an increased risk of permanent lung damage. A possible complication of severe asthma is airway remodeling.

Airway remodeling involves structural changes to the lungs including a thickening of the airways making them narrower. According to research in the American Thoracic Society Journal, airway remodeling may be responsible for chronic inflammation in the lungs.

Severe asthma treatment may involve trying different combinations of medications and lifestyle changes. The good news is there is ongoing research, and new types of medications are being developed to control it.

In addition to trying new combinations of steroids and decreasing triggers, treatment for severe asthma may include the following:

Long-Acting Beta-Agonists

Long-acting beta-agonists (LABAs) may be useful in treating this type of asthma. LABAs are a long-acting bronchodilator that decreases airway constriction for 12 hours.

LABAs have been associated with severe asthma attacks, which is why they are often prescribed with a steroid as a combination medication. LABAs may not be right for everyone with this condition, so talk with your doctor to determine if they may be an option.

Biologic Medications

A new type of medications are now available that may help some people with this type of asthma. Biologic medications work by blocking certain activities of your immune system that may lead to airway inflammation. The biologic drugs may prevent asthma attacks or decrease the severity of symptoms.

One biologic medication used is mepolizumab, which targets eosinophils that may be triggering airway inflammation. Another option is omalizumab, which targets severe asthma due to allergies. The medications are taken intravenously or through an injection.


Tiotropium is an anticholinergic medication that acts as a long-acting bronchodilator. It was typically used to treat symptoms of COPD. But in 2015, the Food and Drug Administration approved it to treat asthma, and it may be effective for some people.

Its critical for people with this type of asthma to also avoid smoking, decrease their risk of infections, and avoid triggers. Talk with your doctor about any other lifestyle changes you can make to control it. It might take a little trial and error to develop a treatment plan for severe asthma, but it’s well worth the effort.