What is severe asthma?

Severe asthma is a type of asthma where symptoms are harder to control, even with high doses of medicines.

It is the most serious and life-threatening type of asthma. In fact, severe asthma is considered a disability under the Equality Act.

Most people with asthma can manage their symptoms well with a preventer inhaler and a reliever inhaler.

Others may need extra support from their GP or asthma nurse, and sometimes add-on treatments, to get better control of their symptoms. These people may be told they have ‘difficult asthma’.

But severe asthma is different. With severe asthma, more specialist treatments are needed to control symptoms and reduce asthma attacks. Sometimes it can take a while to find the combination of medicines and doses that works best for you.

Asthma + Lung UK is supporting research into what causes severe asthma, and what makes it so much harder to control with the usual asthma medicines.

Around 200,000 people in the UK have severe asthma. So, out of 100 people with asthma in the UK, around four have ‘severe asthma.’

Severe asthma affects adults and children.

Find out more about getting a diagnosis for severe asthma.

Having a lot of symptoms over a long period of time, and frequent asthma attacks, can result in changes in the airways. This is known as ’airway remodelling’.

You may also be more at risk of chronic obstructive pulmonary disease (COPD).

Airway remodelling

For most people, changes to the structure of your airways can be avoided with good asthma management. But if you have severe asthma you’re more at risk. Over time the airways of someone with severe asthma can get thicker. This means the airways get more narrow, scarred and inflamed, making it harder to breathe.

Airway remodelling can be treated with bronchial thermoplasty, but this treatment is not recommended for everyone with severe asthma.

COPD and asthma-COPD overlap syndrome

Long-term severe asthma can sometimes lead to a chronic lung condition called chronic obstructive pulmonary disease (COPD) or asthma-COPD overlap (ACO). A spirometry test can be used to confirm these conditions.

Many people with COPD and asthma-COPD overlap syndrome are given physiotherapy and exercises called pulmonary rehabilitation.

Pulmonary rehabilitation has also been shown to help people with severe asthma with their breathing and quality of life.

Long-term steroids effects

Our latest report, Do No Harm, shows that many people with difficult or severe asthma are treated with long-term steroids.

Steroids are lifesaving, and necessary, for so many people with severe asthma. But they can have many difficult side effects, including developing other long-term conditions, like diabetes, osteoporosis, or adrenal insufficiency.

If you take steroid tablets long-term it’s important to talk to your GP about a referral to specialist care. This is so you can be assessed for new biologic treatments. Never stop taking steroids suddenly without advice from your GP.

Biologic treatments

Biologics have been found to make a really positive difference to many people with severe asthma.

They can reduce the dose of steroids you need to take, and help you lead a better quality of life.

If you’re having lots of symptoms and frequent asthma attacks, you might wonder if you have severe asthma.

It’s important to see your GP or asthma nurse for an asthma review as soon as possible. With the right support, most people can get on top of their difficult symptoms.

“We have many callers who tell us they have bad or severe asthma. But often what they really mean is their asthma is not well controlled,’ says Caroline, Respiratory Nurse Specialist, Asthma and Lung UK.

Some people haven’t addressed their triggers, like cigarette smoke. Others have allergies, or other conditions, that could be making their symptoms worse. Only a very small number of all people with asthma will go on to get a diagnosis of severe asthma.

You can read more about severe asthma here.