Difficult-to-control asthma and severe asthma

Millions of people worldwide have asthma, a respiratory condition in which the airways become narrow and constricted due to swelling. 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 people, asthma symptoms persist even when following a treatment plan. These people may have difficult-to-control asthma or a type of difficult-to-control asthma called severe asthma.

Asthma treatment plans

When you are diagnosed with asthma, it’s important to work with your healthcare provider to create an asthma action plan, or treatment plan, to control your condition. This detailed, personalized guide typically outlines your triggers and helps you to identify when symptoms are worsening. It also includes instructions for medication dosage and timing, plus directions for what to do in an emergency. If you have difficult-to-control or severe asthma—or any type of asthma—it’s critical to make sure you have copies of your treatment plan readily available to you.

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 people will need to work harder than others to achieve asthma control.

A person with difficult-to-control asthma will need to take combination inhalers regularly. Combination inhalers combine corticosteroids, which act to tame inflammation, and long-acting bronchodilators, which keep airways open. It’s critical to use proper technique with inhalers, take all medications on a consistent schedule, and avoid triggers and allergens that exacerbate symptoms. Making lifestyle changes that can improve asthma control (such as losing weight, if a person is overweight) is also important.

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 manage. These may include gastroesophageal reflux disease (GERD), vocal cord dysfunction, chronic obstructive pulmonary disease (COPD), 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. People with severe asthma require a more aggressive approach to treatment. This often involves control inhalers, which are typically taken on a daily schedule to help manage symptoms in the long-term. Oral corticosteroids can be used when needed, but only for just a short period of time due to the potential for side effects. Other treatments include biologic therapies (also called immunomodulators), and in some cases, surgery. 

Some people are able to get symptoms under control with aggressive treatment. 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 controlled 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 1.4 million emergency department visits and results in over 3,500 deaths, according to the Centers for Disease Control and Prevention.