Severe asthma is a type of asthma that is difficult to control and can have a significant impact on a person’s daily life. Symptoms of severe asthma can include frequent exacerbations (attacks), high levels of asthma symptoms, and a need for high doses of medication to manage symptoms. Causes of severe asthma can include allergies, exposure to environmental triggers, and genetics. Treatment for severe asthma typically includes a combination of long-term control medications, such as inhaled corticosteroids and bronchodilators, as well as quick-relief medications to be taken during exacerbations. In some cases, additional treatments such as biologic medications or immunomodulators may be needed to manage symptoms.
Types of severe Asthma
There are several subtypes of severe asthma that can be characterized based on specific symptoms and causes. These include:
It’s important to note that some people may have characteristics of more than one subtype of severe asthma. It’s important to work with a healthcare professional to identify your specific subtype of asthma and develop a treatment plan that works for you.
Allergic Asthma
Allergic asthma is a subtype of severe asthma that is caused by an allergic reaction to a specific trigger, such as dust mites, mold, animal dander, pollen, or certain foods. The allergens cause the immune system to overreact and release chemicals, such as histamine, which can lead to inflammation and narrowing of the airways.
- Allergic asthma: characterized by an allergic reaction to a specific trigger, such as dust mites, mold, or pet dander.
- Non-allergic asthma: characterized by symptoms that are not caused by an allergic reaction, but rather by triggers such as viral infections, cold air, or exercise.
- Aspirin-exacerbated respiratory disease (AERD): characterized by severe asthma symptoms that are triggered by the use of aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs)
- Obesity-related asthma: characterized by asthma symptoms that are made worse by being overweight or obese.
- Occupational asthma: characterized by symptoms caused by exposure to specific triggers in the workplace, such as chemicals or dusts.
- Bronchial thermoplasty: characterized by symptoms caused by structural changes in the airways, such as thickening of the muscle layers that can make it harder to breathe.
- Eosinophilic asthma: characterized by a high number of white blood cells called eosinophils in the airways.
Symptoms of allergic asthma can include:
- Shortness of breath
- Wheezing
- Chest tightness
- Coughing, especially at night or early in the morning
- Difficulty breathing, especially during physical activity
- Rapid breathing
Allergic asthma is diagnosed through a combination of medical history, physical examination, and laboratory tests such as skin prick test or blood test (specific IgE) to determine the specific allergens to which an individual is sensitive.
Treatment for allergic asthma typically includes:
- Avoiding exposure to allergens as much as possible
- Long-term control medications, such as inhaled corticosteroids and bronchodilators
- Quick-relief medications to be taken during exacerbations, such as short-acting bronchodilators
- Allergen-specific immunotherapy (allergy shots) to help reduce sensitivity to specific allergens over time.
It’s important to note that many people with allergic asthma also have other allergic conditions, such as hay fever, eczema, or hives. They may have benefit from a comprehensive allergy management plan, including allergy testing and immunotherapy.
Non allergic asthma
Non-allergic asthma is a subtype of severe asthma that is not caused by an allergic reaction, but rather by other triggers such as viral infections, cold air, exercise, stress, or exposure to certain chemicals or pollutants. The exact cause of non-allergic asthma is not known, but it is thought to be related to changes in the airways that make them more sensitive to certain triggers.
Symptoms of non-allergic asthma can include:
- Shortness of breath
- Wheezing
- Chest tightness
- Coughing, especially at night or early in the morning
- Difficulty breathing, especially during physical activity
- Rapid breathing
Non-allergic asthma is diagnosed through a combination of medical history, physical examination, and laboratory tests such as pulmonary function test, to rule out other causes of asthma like infections or structural changes.
Treatment for non-allergic asthma typically includes:
- Identifying and avoiding triggers as much as possible
- Long-term control medications, such as inhaled corticosteroids and bronchodilators
- Quick-relief medications to be taken during exacerbations, such as short-acting bronchodilators
- Monitoring of symptoms and lung function regularly
It’s important to note that non-allergic asthma and allergic asthma can have similar symptoms and the distinction between the two subtypes can be difficult. A healthcare professional will work with you to identify the specific triggers of your asthma and create an individualized treatment plan.
Mucus Plugs and Asthma
Mucus plugs, also known as bronchial plugs, can be a complication of asthma. Mucus plugs are clumps of thick, sticky mucus that can block the airways and make it harder to breathe. They can form in the airways of people with asthma as a result of inflammation and increased mucus production in the lungs.
Symptoms of mucus plugs in asthma can include:
- Shortness of breath
- Wheezing
- Chest tightness
- Coughing, especially at night or early in the morning
- Difficulty breathing, especially during physical activity
- Rapid breathing
- Wet or gurgling sounds when breathing
- Increased mucus production and difficulty clearing mucus from the lungs
Mucus plugs can be caused by a number of factors, including exposure to triggers such as allergens, viral infections, or pollutants, as well as by changes in the airways that make them more sensitive to certain triggers.
Treatment for mucus plugs in asthma typically includes:
If you have asthma and are experiencing symptoms of mucus plugs, it’s important to speak with your healthcare professional to develop an individualized treatment plan. In some cases, additional treatments such as biologic medications or immunomodulators may be needed to manage symptoms.
Wheezing and Severe Asthma
Wheezing is a common symptom of severe asthma, as well as other types of asthma. It is a whistling or whistling sound that can be heard when breathing, especially during exhalation. Wheezing is caused by narrowed or obstructed airways, which can make it harder to breathe.
In severe asthma, wheezing can be a sign of increased inflammation and narrowing of the airways, which can lead to difficulty breathing and increased risk of exacerbations. The increased airflow resistance leads to increased air movement velocity, generating the wheezing sound.
Symptoms of severe asthma can include:
- Frequent exacerbations (attacks)
- High levels of asthma symptoms, such as shortness of breath, chest tightness, and coughing
- A need for high doses of medication to manage symptoms
- Increased risk of hospitalization
- Difficulty with daily activities and impairment of quality of life
Treatment for severe asthma typically includes a combination of long-term control medications, such as inhaled corticosteroids and bronchodilators, as well as quick-relief medications to be taken during exacerbations. In some cases, additional treatments such as biologic medications or immunomodulators may be needed to manage symptoms.
It’s important to work closely with a healthcare professional to develop an individualized treatment plan for severe asthma. This may include regular monitoring of symptoms and lung function, as well as a plan to manage exacerbations and prevent future attacks.
- Identifying and avoiding triggers as much as possible
- Long-term control medications, such as inhaled corticosteroids and bronchodilators
- Quick-relief medications to be taken during exacerbations, such as short-acting bronchodilators
- Chest physical therapy, such as chest clapping and vibration, to help remove mucus from the lungs
- Monitoring of symptoms and lung function regularly