Severe Asthma vs. Asthma With Severe Attacks

Nearly 339 million people worldwide have asthma. But only a small slice of that group has what’s considered “severe asthma.” Here’s what sets apart severe asthma from regular asthma with severe attacks.

Severe Asthma

Asthma falls into categories that range from intermittent (meaning no more than 2 days of wheezing and coughing per week) to persistent. If it’s persistent, the condition can be further classified: either mild, moderate, or severe.

Severe asthma is the least common type. Symptoms happen every day and are frequent enough to affect daily life and sleep. Left untreated, lungs function at less than 60% of their normal level.

Treatment involves high-dose inhaled corticosteroids plus a second medicine to control symptoms. Both can bring side effects. Sometimes severe asthma can remain uncontrolled even when treated.

Not everyone’s severe asthma has the same traits. Differences can include:

  • How well your lungs work
  • Which symptoms you have
  • How young you are when you get it
  • Which medications you use

If you have severe asthma, it’s important to take care of yourself and to control your disease. See your doctor regularly, fill your prescriptions, and take your meds as directed.

Try to live a healthy lifestyle, too. Both smoking and obesity have been linked to severe asthma.

If you find your symptoms are becoming worse, or they happen more often, biologic therapies might help. These meds target molecules in your body, like certain white blood cells, for example, that are involved in asthma.

Ask your doctor about them.

Severe Attacks

Severe asthma attacks, on the other hand, are medical emergencies. During these, your shortness of breath won’t go away with treatment.

About half of severe attacks are caused by upper respiratory infections. Not taking your asthma medicines or not seeing your doctor often enough can lead to attacks, as can allergic reactions to:

  • Specific drugs
  • Some animals
  • Smoke or other irritants

Signs of a severe attack include:

  • Worse symptoms than usual
  • Shortness of breath that makes it hard to speak, eat, or sleep
  • Fast breathing
  • Lower peak flow than normal
  • Your inhaler doesn’t help

The symptoms don’t always come on suddenly. They can build up over the course of days.

If you think you’re having a severe attack, take it seriously:

  • Sit upright.
  • Breathe steadily.
  • Stay calm.
  • Use your rescue inhaler every 30 to 60 seconds, up to 10 times.
  • Call 911 if you don’t have your inhaler on hand, or you feel like the inhaler either isn’t working, or your symptoms are getting worse.
WebMD Medical Reference Reviewed by Carol DerSarkissian on August 25, 2020

Sources

SOURCES:

Lancet: "GBD 2015 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015."

GlobalAsthmaReport.org.

healthychildren.org: “Mild, Moderate, Severe Asthma: What Do Grades Mean?”

Stanford Children’s Health: “Levels of Asthma.”

Seminars in Respiratory and Critical Care Medicine: "Diagnosis and Management of Severe Asthma."

Journal of Allergy and Clinical Immunology: In Practice: "Severe Asthma Phenotypes – How Should They Guide Evaluation and Treatment?"

Cleveland Clinic: “Biologic Therapy for Severe Asthma.”

Shah R, Saltoun CA. Chapter 14: Acute severe asthma (status asthmaticus). Allergy and Asthma Proceedings, Volume 33, Supplement 1, May/June 2012, pp. S47-S50(4).

National Health Service: “Asthma attacks.”

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