What is severe asthma and how do you know if you have it?

GB-37402 DOP 04-2023

What is classed as severe asthma?

Less than 10% of people with asthma are diagnosed as having severe asthma. More unpredictable and harder to manage than mild and moderate asthma, severe asthma is the most debilitating form of this condition.

Those with mild, moderate, or severe asthma may share the same common asthma symptoms of breathlessness, wheezing, and coughing, but there are a few key differences with severe asthma:

• Symptoms are much worse and can last much longer.

• Symptoms often occur daily and have a huge effect on people's lives.

• Symptoms don't always respond well to standard asthma treatments and medications.

"Individuals with severe asthma will experience continuous symptoms daily, despite taking their asthma medication," says Margaret Kelman, specialist allergy nurse at Allergy UK. "They will experience frequent asthma attacks and often be admitted to hospital for their asthma."

While this can sound scary, there are specific asthma treatments and lifestyle changes that can make a significant, positive difference in people's lives. Getting a diagnosis of severe asthma is an important first step in creating an asthma action plan that can help you to gain better control of your condition.

How is severe asthma treated and managed?

Despite the risks, there is a history of people not following specialist severe asthma treatment advice properly. Trying to get severe asthma under control can be disheartening, and it can take time to find the right treatment combination for you.

Patient picks for Asthma

Chest and lungs

What are the best forms of exercise if you have asthma?

Physical activity is good for people with asthma. It improves lung function, supports the immune system and helps keep people’s weight down, cutting the risk of an asthma attack. However, since some people with asthma find that exercise triggers their symptoms, they may feel apprehensive about getting started.

Chest and lungs

Asthma inhalers

An inhaler is a device containing a medicine that you take by breathing in (inhaling). Inhalers are the main treatment for asthma and help to control asthma symptoms. There are many different types of inhaler, which can be confusing. This leaflet gives information on the medicines inside inhalers, the types of inhaler device and some general information about inhalers. This leaflet is only about inhalers for asthma. It is important to recognise that the same inhalers can be used in other medical conditions (for example, chronic obstructive pulmonary disease) but that the way they are used will be different.

by Dr Pippa Vincent, MRCGP

But remember, with the right treatment plan in place, it's possible to manage asthma and improve your quality of life significantly.

• Take care of yourself and control of your asthma by:

  • Taking your medication as prescribed. This will include learning the correct inhaler technique and may also include other medications as recommended.

  • Attending your hospital appointments if you're referred.

In the last few years, several new treatments have become available for people with severe asthma. These include medicines given by injection, antibody therapy, or bronchial thermoplasty. However, they are usually only available through specialist clinics.

Following your asthma action plan

This is a tailored treatment plan agreed with your healthcare team which includes both asthma medications and non-medicinal methods of management.

Attending regular asthma reviews

This will allow your healthcare team to reassess your severity and adjust your asthma action plan if needed - for example, identifying new treatment options and increasing asthma medications to a higher dose if required.

Avoiding your asthma triggers where possible

Everyone's triggers are different, but this might include staying inside when the pollen count is high, or having your house assessed for house mites and mould volume.

Making sensible lifestyle adjustments

Being fit and healthy can dramatically improve your asthma. You should refrain from smoking, eat healthily, exercise regularly, and if you're overweight or obese aim to reach a healthy weight.

Penny's story

Penny's experience is an inspiring example of the benefits of exercise and diet. However, it's important to note that everyone is different and not every person with severe asthma will see the same results. You should always follow the advice of your healthcare professional.

How I used fitness to reduce my symptoms after a collapsed lung

At the age of 26, fitness and nutrition expert Penny Weston suffered a collapsed lung due to suffering from severe and chronic asthma from a young age.

"It was incredibly scary to be totally out of breath whilst lying down, and a huge wake-up call for me. I was terrified!" she says. "I had to rest on the sofa and not move for days."

Following this terrifying ordeal, Penny focused on improving her health through exercise, diet, and nutrition. Now, she is the director of award-winning Moddershall Oaks Country Spa Retreat and founder of MADE wellness centre.

"I started getting into fitness to try to help my lungs and asthma. Initially, I went to circuit training classes with a friend. The stop-start nature of circuits, and later HIIT training, helped to strengthen my lungs.

"As time went on, I became fitter and more confident. I also realised that I really liked what fitness and healthy food had done to my body and my life, and I saw an opportunity to help other people enrich their lives."

Penny now no longer needs to take the steroid tablets that she was told she'd be on forever. "I went to the doctor after about three or four years of training and while they said, "you can't cure asthma", they confirmed I had gone from a 9/10 severity to a 1/10. I had reduced my asthma to the least severe it could be.

"Now day-to-day, asthma doesn't affect me, but I am prone to chest infections, so I have a reliever inhaler. If I get a cold or a cough, my chest can get quite tight, and I have to take antibiotics, so that's when the asthma flares up.

"I used to avoid being active, but it's increasing my fitness that contributed to helping my asthma."

How to exercise with severe asthma

"If you're worried that doing any physical exercise will set off your asthma, it's a good idea to speak with your GP or nurse and agree a plan of action," says Kelman. "When exercising, make sure your reliever medication is easily accessible, follow your personal asthma action plan to identify when your asthma is not well managed, and get to know your triggers so that you can avoid them where possible."