What Is The Difference Between Asthma And Severe Asthma? Know When You Should Approach A Specialist

Severe asthma is when asthma remains uncontrolled, despite controlling the modifiable risk factors and use of high-dose medications.

While severe asthma can pose day-to-day challenges, underestimating or ignoring its severity can be harmful. Seeking consultation from an asthma specialist or a pulmonologist at the earliest is recommended.

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By Dr. Shivanshu Raj Goyal

Asthma is a chronic condition, characterised by inflammation in the airways, which restricts breathing. The Global Burden of Disease (1990–2019) estimates that India accounts for 13.09% of the global asthma burden. However, asthma may present very differently for everyone, from the triggers to the attacks. Some forms, like severe asthma, can be quite debilitating and require specialised treatment. 

How is severe asthma different?

Severe asthma is when asthma remains uncontrolled, despite controlling the modifiable risk factors and use of high-dose medications. An estimated 5-10% of asthma patients globally have severe asthma. Though a small subset, the numbers can be quite problematic for India, which has a large population and is a hotbed of several asthma triggers, including air pollution. 

For a severe asthma patient, symptoms tend to be more intense and persistent as they may not get better with the usual treatment modalities. Frequent and serious asthma attacks may also occur. 

Besides the risk of exacerbations, living with severe asthma can be frustrating. It can require several lifestyle changes and may limit movement. Coping with these changes can take a toll on an individual's overall health, day-to-day life, productivity and relationships.

Some key symptoms of severe asthma include: 

• Enhanced frequency of symptoms (such as chest tightness, and breathing difficulties), particularly during night-time
• Increased disruption of day-to-day activities
• Excessive reliance on rescue or reliever medicines (more than twice a week)
• Frequent hospitalisation

When should a patient seek medical advice? 

Getting an accurate diagnosis forms the core of effective treatment. While severe asthma can pose day-to-day challenges, underestimating or ignoring its severity can be harmful. Seeking consultation from an asthma specialist or a pulmonologist at the earliest is recommended.

The doctor may use several tests to detect severe asthma. The presence of comorbidities, which can aggravate asthma flare ups, should also be investigated., Some of the tests for severe asthma include:

• Pulmonary/lung function test (PFT)
• Fraction of exhaled nitric oxide (FeNO) test 
• Blood tests to understand the precise cause of inflammation

Doctors can also prescribe certain self-assessment tools to the patients under treatment to assess their long-term asthma control. Some of these are available online and generate scores which help in determining control. 

How is severe asthma treated?

While there is no single treatment for severe asthma, steroids are normally added to the standard regimen of high-dose inhaled therapy. Today, pharmacological treatment modalities have become extremely advanced and personalised. 

Diligently following a healthy lifestyle, good diet and avoiding smoking in all forms is crucial to keep the lungs healthy. Consult your doctor today to know the best-suited asthma treatment options.

(The author is a consultant, Respiratory/ Pulmonology & Sleep Medicine, Artemis Hospitals)

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