By Dr. Rahul Sharma

Ramesh (46, name changed) had been suffering from asthma for the past 6 years. He was on inhaled medication for maintenance of his condition and quick relief from symptoms when there was a flare-up. Though he had been taking his medication regularly, he was waking up more often at night with severe bouts of cough, making him reach out for his quick-relief inhaler. Things came to a head when he had to be hospitalised last month due to a severe escalation. On consulting a specialist (pulmonologist), he was diagnosed with severe asthma.

Asthma is a life-long inflammatory disease affecting airways and interfering with one’s ability to breathe. Asthmatic attacks are usually triggered by exposure to certain allergens such as pet dander, moulds, or pollen. Severe asthma is commonly confused with milder forms but can be life-threatening and may require emergency medical care. As an asthmatic patient, if you experience any signs of worsening health or struggle to find relief from your current medication, it may be time to talk to the doctor.

Signs of severe asthma

Severe asthma attacks are chronic and can interfere with your life. Even breathing or talking can become difficult. Some of the common symptoms include coughing, wheezing, tightness around the chest, and breathlessness.

Besides experiencing recurrent symptoms, severe asthma can be deduced if you experience:

  • Exacerbation of symptoms despite optimal medication use
  • Increase in symptoms and flare-ups during the night
  • Need for quick-relief medications more than twice a week
  • More than two hospital visits or admissions in a year due to flare-ups

Understanding what causes your severe asthma

Patients with severe asthma may continue to exhibit symptoms in spite of optimal inhaled treatment and lifestyle modifications.Most patients, in consultation with their doctors, are treated with oral corticosteroids which result in several detrimental side effects. However, recent research studies show that several mechanisms are at work in severe asthma. Depending upon the underlying causes of the inflammation, severe asthma can be divided into allergic, eosinophilic, or non-eosinophilic asthma. Hence, it is important to identify the root cause and customise the treatment accordingly.

Targeted treatments such as biologics are now available and may be added to the existing therapy by the clinician after assessing the patient. Biologics are specific injectable therapies that offer relief from persistent symptoms in severe asthma and reduce the need for oral steroids.

Assessing asthma control

There are several asthma control tests that a patient can avail of to judge their condition. An online asthma control test is a simple test that measures the impact of asthma on the patient’s daily life and generates an appropriate score. Even patients undergoing treatment are advised to take frequent self-assessment tests.

Do not ignore your symptoms and seek treatment

The key target of any treatment is to reduce symptomatic flare-ups and improve a patient’s quality of life. Reviewing inhalation techniques and limiting triggers while regularly consulting a physician is also advised for better asthma control. As patients with severe asthma are already on high-dose inhalers, oral corticosteroids are often suggested by physicians to manage episodes. Newer and more advanced therapies are now available, in the form of add-on oral medications and biological therapies. Consult your doctor today to understand your symptoms better and seek the right kind of treatment for your condition!

(The author is the Additional Director Pulmonology & Critical Care, Fortis Hospital, Noida. The article is for informational purposes only. Please consult medical experts and health professionals before starting any therapy, medication and/or remedy. Views expressed are personal and do not reflect the official position or policy of the

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