Severe uncontrolled asthma affects only a small proportion of people with asthma, accounting for around 5% of all cases, but it has a significant impact on both patients' quality of life and the healthcare system.
Asthma is a chronic condition in which the airways become inflamed and narrowed, making it more difficult for air to flow in and out of the lungs. In most cases, symptoms such as coughing, shortness of breath, chest tightness and/or wheezing can be effectively controlled with inhaled medication. However, in people with severe uncontrolled asthma, these symptoms persist despite taking their prescribed medication correctly.
Features of severe asthma
Severe asthma is characterised by:
- Frequent asthma attacks.
- Repeated need for reliever inhalers.
- Visits to the emergency department or hospital admissions in the most severe cases.
People living with severe asthma may experience significant limitations in their daily lives, making it difficult to exercise, work or even get a good night's sleep.
The causes of severe uncontrolled asthma are varied and complex. In many cases, a combination of factors is involved, including genetic predisposition, ongoing exposure to allergens or air pollutants, respiratory infections, and exposure to tobacco smoke. In some patients, the condition is also characterised by a particularly severe inflammation that does not respond to conventional treatments.
Why does asthma remain uncontrolled? Key considerations
One of the most important steps in managing severe uncontrolled asthma is ensuring an accurate diagnosis and a comprehensive assessment. This includes tests such as spirometry and peak expiratory flow rate, to assess lung function, as well as other investigations to assess airway inflammation.
It is also essential to check that patients are using their inhalers correctly, as incorrect use may reduce the amount of medication delivered to the lungs.
Treating severe uncontrolled asthma requires a more specialised approach. In addition to standard inhaled medication, biologic therapies may be used to target specific inflammatory pathways. These treatments have represented a major advance in recent years, as they can help to reduce exacerbations and improve patients' quality of life.
However, pharmacological treatment is only one part of effective asthma management. Controlling exposure to triggers is equally important. Reducing exposure to allergens, avoiding tobacco smoke and maintaining a healthy environment can all make a significant difference. Appropriate levels of regular physical activity, such as walking or swimming, are also encouraged, as they can help improve respiratory capacity.
Common myths about severe asthma
Another important challenge is the widespread misconception about asthma. Some people still believe that if they are not experiencing symptoms, there is no need to continue their maintenance treatment. However, stopping treatment in this way can lead to poorer asthma control. For people with severe asthma, sticking to their prescribed treatment is even more important.
Finally, it is important to remember that there is currently no cure for asthma. However, with regular medical follow-up, a personalised treatment plan and good patient education, it is possible to reduce symptoms and lead an active life.
Severe uncontrolled asthma highlights the fact that not all forms of asthma are the same. Identifying those patients with the most complex forms of the condition and providing personalised care is essential to ensure they receive the support and treatment they need to breathe more easily.
INFORMATION DOCUMENTED BY:
Dr Ebymar Arismendi, Clínic Respiratory Institute, Hospital Clínic Barcelona.
