Everything you need to know about severe asthma

Asthma is a type of respiratory disorder that causes a swelling of the airways in the lungs. Some symptoms of this condition are discomfort in the chest area, shortness of breath, wheezing or whistling sounds while breathing, trouble sleeping due to coughing or wheezing, and increased vulnerability to common colds and flu. If these symptoms occur consistently, i.e., on most days of the week, then it might signify the beginning of severe asthma.

How is severe asthma diagnosed?
The symptoms of severe asthma can mimic other respiratory conditions, and it is difficult to deal with the illness if left untreated for a long time. Therefore, it is essential to consult a pulmonologist for a proper diagnosis. The doctor will use the following methods to confirm a case of severe asthma.

• Physical exam – To rule out the possibility of other conditions such as COPD (chronic obstructive pulmonary disease) or respiratory infections, the doctor will carry out a physical exam and inquire about the signs and symptoms one has been experiencing lately.

To understand the lung function, the doctor may order for tests such as spirometry and peak flow to assess how the air moves in the lungs as one breathes in and out. Typically, these tests are done before and after administering a medicine known as a bronchodilator to open up the lungs. If the lung function improves with the use of a bronchodilator, then it indicates that the person is suffering from asthma.

• Spirometry – This test determines how narrow the bronchial tubes have become by monitoring the amount of air one can exhale after taking a deep breath in a specific number of seconds.
• Peak flow – A simple device, a peak flow meter gauges how much effort one has to take while exhaling. Low peak flow readings indicate that the lungs are not functioning well and the asthma is getting severe. To keep severe asthma in check, the pulmonologist will guide the patient on monitoring and managing low peak flow rates.

Apart from these tests, the pulmonologist might also recommend some diagnostic tests stated below to understand the case and implement the best treatment for severe asthma.

• Nitric oxide test
• Methacholine challenge
• Imaging tests such as x-ray or computerized tomography (CT) scan
• Sputum eosinophils
• Provocative testing for exercise and cold-induced asthma
• Allergy testing

What kind of medications and treatments are used to manage the symptoms of severe asthma?
Long-term and rescue medications are both used to control symptoms of severe asthma. The former are types of chronic asthma medications that are supposed to be taken every day for preventing episodes of asthma attacks. On the other hand, rescue medications are used during an attack to relieve the symptoms.

Long-term chronic asthma medications

• Leukotriene modifiers
• Long-acting beta-agonists
• Inhaled corticosteroids
• Combination inhalers

Rescue medications

• Short-acting beta-agonists
• Oral and intravenous corticosteroids

Apart from chronic asthma medications, people having allergies are recommended to get allergy shots to strengthen their immune system’s response to any allergens.

Bronchial thermoplasty

• If severe asthma doesn’t improve with the help of chronic asthma medications, then bronchial thermoplasty might be advised.
• In this procedure, the insides of the airways are heated with an electrode which reduces the smooth muscle layer. This restricts the ability of the airways to tighten which makes breathing simpler and diminishes the possibility of an asthma attack.

What lifestyle changes are recommended for individuals with severe asthma?
To ease the frequency of attacks, apart from chronic asthma treatment, one should try adopting the below-stated lifestyle changes.

• Avoid contact with allergens or exposure to an environment with chemicals or irritants
• Maintain a healthy weight
• Abstinence
• Get flu and pneumonia shots to avoid flare-ups
• Monitor any changes in breathing as it could be a warning sign of a flare-up

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