Advertisement

Difficult-to-Control Asthma and Severe Asthma

When asthma symptoms persist, a person may have difficult-to-control asthma or severe asthma. Learn what these terms mean.

asthma treatment equipment

Medically reviewed in December 2020

Millions of people worldwide have asthma, a respiratory condition where the airways become narrow and constricted. This swelling can be exacerbated by allergens, irritants in the air, illness (like having a cold or the flu), stress, weather, medications, and physical activity. Exacerbations are often referred to as “asthma attacks.”

Asthma is a chronic condition, meaning there is no cure. Treatment for asthma focuses on monitoring and control. This includes preventing asthma attacks, addressing asthma attacks when they occur, reducing the impact that asthma has on everyday life and activities, and limiting the long-term impact that asthma has on lung function.

For some patients, asthma symptoms persist even when following a treatment plan. These patients may have difficult-to-control asthma or a type of difficult-to-control asthma called severe asthma.

Difficult-to-control asthma
Treatment for difficult-to-control asthma involves identifying and addressing any weak points in a treatment plan. Because asthma varies significantly from person to person, some patients will need to work harder than others to achieve asthma control.

A person with difficult-to-control asthma will need to take corticosteroid inhalers regularly, use proper technique with inhalers, take all medications on a consistent schedule, avoid triggers and allergens that exacerbate symptoms, and make lifestyle changes that can improve asthma control (such as losing weight, if a person is overweight).

If you are having difficulty getting your asthma under control, it is important that you and your healthcare provider identify other health conditions that could be causing your symptoms or making your asthma more difficult to control, such as GERD (gastroesophageal reflux disease), vocal cord dysfunction, COPD (chronic obstructive pulmonary disease), or obesity. Working with your healthcare provider to get a full picture of your overall health is important to treating asthma.

Severe asthma
Severe asthma is a subcategory of difficult-to-control asthma. Patients with severe asthma require a more aggressive approach to treatment, such as control medications, high-dose corticosteroids, biologic therapies (also called immunomodulators), and in some cases, surgery. Some are able to get symptoms under control with aggressive treatment, while others are not able to achieve well-controlled asthma, even with aggressive treatment.

If your asthma symptoms persist despite following a treatment plan, it is important that you continue to work with your healthcare provider to find a treatment approach that works. While asthma is a relatively common condition, it should not be taken lightly. Asthma that is not uncontrolled and/or severe can have a major impact on a person’s quality of life and can cause serious complications. In a given year, asthma is the main cause for more than 1.7 million emergency room visits and results in over 3,000 deaths.

Article sources open article sources

American Academy of Allergy, Asthma & Immunology. Asthma Overview.
UpToDate. Treatment of severe asthma in adolescents and adults.
Centers for Disease Control and Prevention. Asthma.
National Heart, Lung, and Blood Institute. What is Asthma?
American Lung Association. Managing Asthma.
Merck Manual Consumer Version. Asthma.
Asthma and Allergy Foundation of America. Allergens and Allergic Asthma.
James T. Li, John Oppenheimer, et al. Attaining optimal asthma control: A practice
parameter. Journal of Allergy and Clinical Immunology, 2005. Vol. 116, No. 5.
John T. Lindsay and Liam G. Heaney. Nonadherence in difficult asthma – facts, myths, and a time to act. Patient Preference and Adherence, 2013. Vol. 7.
American Academy of Allergy, Asthma & Immunology. Severe Asthma.
Cleveland Clinic. Biologic Therapy for Severe Asthma. 
Cleveland Clinic. Treating the Inflammation of Asthma.
Asthma + Lung UK. Difficult to control asthma.
University of Virigina School of Medicine. Asthma Attacks.
Asthma and Allergy Foundation of America. Asthma Action Plan.
Jenna R. Murdoch and Clare M. Lloyd. Chronic inflammation and asthma. Mutation Research, 2010. Vol. 690, No. 1-2.
Mike Thomas. Allergic rhinitis: evidence for impact on asthma. BMC Pulmonary Medicine, 2006. Vol. 6, Suppl. 1.

Featured Content

article

Have Asthma? 6 Ways To Improve Your Indoor Air Quality

Dust mites, mold and even the family dog can affect your breathing. Take these steps to keep allergens in check.
article

5 Strategies for Getting the Most Out of Asthma Treatment

No one knows how to cure asthma yet but finding the best treatment plan helps keep your asthma symptoms in check. 
article

6 Important Vaccines for People with Asthma

Get these shots to boost your health.
article

How E-Asthma Is Different from Other Types of Asthma

Learn five ways in which eosinophilic asthma is different than other subtypes of asthma.
article

Treatments for Eosinophilic Asthma

Learn about the different options for treating eosinophilic asthma, and the importance of an asthma action plan.