Uncontrolled Asthma vs. Severe Asthma: How to Get the Right DiagnosisFrequent asthma flare-ups can be difficult to manage, but they also can be a sign that something else is wrong.
More than 25 million Americans struggle with asthma, a chronic condition that makes breathing difficult. Whether you have lived with asthma since childhood or developed it later in life, it is important to monitor your symptoms and avoid your triggers to manage the disease. Many times, regular flare-ups can be treated with a combination of quick-relief and controller medications. Unfortunately, this may not be enough to get your symptoms under control.
If you feel asthma is interfering with your life, it can be frustrating to know what to do next. This is when it may be time to talk to your doctor about the possibility of severe asthma.
Daily symptoms, such as chest tightness, shortness of breath, coughing and wheezing, are signs of uncontrolled asthma and may require the use of quick-relief medication a few times a week or even daily. In addition, you may commonly experience nighttime flare-ups and may even have to visit the emergency room. As you might expect, with these symptoms you may miss work, stop exercising, and have difficulty performing daily tasks. If you have signs of uncontrolled asthma as listed above, you will want to discuss this with you physician because you may be able to find a solution.
If you have mild to moderate asthma with uncontrolled symptoms, you may potentially be better controlled with adjustments to your treatment plan. Your doctor will want to evaluate the effectiveness of your current medication, as well as assess current lung function and determine your common triggers. This can be done by keeping an asthma diary or answering an asthma symptoms questionnaire. You may need to have a spirometry test, which is a simple, noninvasive breathing test to assess your current lung function.
In addition, your doctor may want to watch you use your inhaler to correct any errors in how you may be using it. They will most likely recommend that you avoid triggers and evaluate your current lifestyle for risk factors or other factors that cause increased symptoms or flareups. Smoking, beta-blocker medicines, allergen exposure, obesity, GERD, and depression or anxiety are just a few things that have been linked to contributing to asthma flare-ups. After evaluating all these factors, your doctor will likely want to adjust your medication to find something that is more effective, including adding an inhaled controller medicine if not already prescribed.
But what if you continue to struggle?
If after 3–6 months, your current treatment plan, which already includes a high-dose inhaled corticosteroid, a second controller medicine and/or an oral corticosteroid, is still ineffective, it may be severe asthma. Unlike uncontrolled asthma which improves with treatment changes, if you have severe asthma you will continue to have daily symptoms despite maximized optimal therapy. Other signals of severe asthma include waking every night due to asthma symptoms, two or more emergency department visits or hospitalizations in a year and the use of oral corticosteroids to manage symptoms.
At this point, your doctor will refer you to a specialist, either a pulmonologist or an allergist, to provide further testing to determine if you have severe asthma. They will be testing for biomarkers, which are identifiers in your immune system, blood, breath or mucus that cause Type 2 inflammation. Once a severe asthma diagnosis is confirmed they will help you find a personalized treatment plan that may include new medicines, such as biologics. When talking to your specialist, it may helpful to use our Severe Asthma Shared Decision-Making Worksheet to get the conversation started.
Think you may have severe asthma? Take our Asthma Control Assessment, to help identify if your asthma is uncontrolled and access a downloadable summary to take with you to your next doctor’s appointment.
Blog last updated: March 13, 2020