How is severe asthma treated?

Most people with asthma manage well with a regular steroid preventer inhaler, and a reliever inhaler for when they get symptoms.

Some people with asthma that’s difficult to control benefit from a higher dose in their preventer inhaler, or further add-on treatments like a preventer tablet (montelukast) or a long-acting bronchodilator (LABA).

People with severe asthma need extra treatments to control symptoms - for example, some or all of the following:

• a regular inhaled corticosteroid, often at a high dose
• an additional add-on treatment such as a long-acting muscarinic antagonist (LAMA) which is a different type of long-acting bronchodilator - for example, tiotropium (Spiriva Respimat)
• oral corticosteroids (steroid tablets), usually prednisolone
• biologics (monoclonal antibodies) such as mepolizumab

Some may be eligible for bronchial thermoplasty or advised by their specialist to have a nebuliser at home.

A few people with severe asthma may be prescribed a kind of antibiotic called a macrolide, usually azithromycin. Studies suggest that some people with severe asthma may benefit from regular antibiotic treatment, but it is hard to know which individuals will be helped, and which won’t.

Biologic treatments (monoclonal antibodies) 

Some people with asthma are eligible for biological treatments called monoclonal antibodies. These can treat some types of severe asthma, by helping to stop body processes that cause lung inflammation.

Monoclonal antibodies are not suitable for every type of severe asthma, but they can be life-changing for those who can access them. Find out if you may be eligible for an assessment for biologics.

Find out more about biologic treatments for asthma.

Steroid tablets 

People with severe asthma who aren’t eligible for biologics, or who haven’t yet been referred to a specialist, may be treated with oral corticosteroids (tablets) alongside their usual steroid inhaler and other add-on treatments.

Steroid tablets are an important treatment for people with severe asthma and can help to reduce symptoms and the risk of having a life-threatening asthma attack.

But as our severe asthma report shows, steroid tablets taken in the long term can cause harmful side effects. If you need to take repeated courses of oral steroids to keep symptoms under control, it’s important to keep taking them, but do ask your doctor or specialist for a referral.

Find out more about steroid tablets for severe asthma.

Bronchial thermoplasty 

Some people with severe asthma may benefit from a surgical procedure called bronchial thermoplasty. Bronchial thermoplasty uses heat treatment to reduce thickening on the walls of the airways, opening them up and making it easier to breathe.

Find out more about bronchial thermoplasty.  

Nebulisers 

Nebulisers are mostly used in an emergency in A&E and hospital, or by paramedics treating you at home or in the ambulance.

But some people with severe asthma are prescribed nebuliser medicines to use at home.

Find out why you should only use a nebuliser at home if your doctor or specialist recommends one and prescribes the medicines to put into it.

Severe asthma varies from person to person, and everyone has their own signs, symptoms and triggers. That’s why treatments for severe asthma can’t take a one size fits all approach.

Your doctor and your specialist team need to work with you to find the best treatment plan for you and your type of severe asthma.

This means understanding what it is in your body that triggers inflammation, or why your body does or does not respond to steroids. This personalised approach offers the best chance of improving symptom control and quality of life.  

To make sure your treatment plan is personal to you, and that you can get the most benefits from it, your doctor or specialist team should work with you to:

• understand your symptoms, what makes them worse and what helps them
• deal with any side effects from your medicines, including any interactions with other medicines you take
• look at other related conditions that could be making your asthma worse
• talk honestly about lifestyle and anything that could be making symptoms worse, like smoking, stress, or excess weight
• find solutions to help you stick to your medicine routine
• help you reduce your medicines safely, if you’re able to
• help you benefit from other specialists in the clinic, such as psychologists, speech and language therapists, and physiotherapists.

Other related conditions

It’s important to get support for other conditions commonly seen with asthma too, such as allergic rhinitis, sleep apnoea and depression, which can make severe asthma worse and harder to control.

These and other conditions are common in people who have severe asthma. But with the right support and treatment you should see improvements, and to your asthma too.

Managing all your medicines can be challenging, especially if you also need medicines for other conditions, or to help you deal with conditions caused as a side effect from taking long-term steroids.

Here are 5 top tips to help you keep on top of your daily medicines: 

1. Get into a good routine – some people find it helpful to take their medicines at the same time, and in the same place, every day. Or to link taking their daily medicines to another activity they do every day, like brushing their teeth, or having their morning tea or coffee. You could use an app on your phone to set daily reminders, or keep a medicines diary or chart, which you tick off every day. Help anyone who lives with you to understand your medicines routine, so they can support you with it
2. Try using a tablet organiser (dosette box) to help you know what pills you need to take every day
3. Keep all your medicines in the same place, along with patient information leaflets, an up-to-date list of all your medicines and their doses, and your asthma action plan
4. Ask the pharmacist before using other over-the-counter medicines like painkillers, vitamins, herbal remedies and cold remedies
5. Set up repeat prescriptions – and set a reminder, so you don’t run out of essential medicines. For example, you could write ‘order new meds’ on your calendar a week or so before you know you’re due to run out.