1 in 20 people with asthma have severe asthma

How is severe asthma treated?

Severe asthma can vary from person to person so your treatment will be tailored to your individual needs

Severe asthma is very individual. There’s no one-size-fits-all treatment so your healthcare professional will tailor your medicines to you. That’s why working in partnership with them is such an important part of your treatment plan. Taking your medicines as agreed, reporting back on improvements and any side effects you’ve noticed, and using your written asthma action plan are all important ways to manage severe asthma along with your healthcare team.

Can severe asthma be managed successfully?

There's no doubt that severe asthma is harder to manage but it might be reassuring to know there are treatments available that can help keep your asthma as controlled as possible. Most people with severe asthma will take the same medicines as other people with asthma. But you will need to take higher doses of medicines and you may also need extra medicines and newer treatments. Plus, it can take time to find the combination of treatments that works for you. In an Asthma UK survey, 41 percent of people with severe asthma told us it’s taken a few years to get their medicines right, although this can vary from person to person

While it can seem unfair that you have to take lots of medicine compared to most people with asthma, remember these treatments could be saving you from having a potentially life-threatening asthma attack. And asthma can change over time, so you might not always need to take all these medicines at the same dose.

What’s key is that you have an honest and productive relationship with your healthcare professionals so you can get the support you really need. For example, taking your medicines as agreed with your healthcare professional is crucial. But lots of people with all sorts of health conditions don’t do this.

We know 45 percent of people with severe asthma who are prescribed steroid tablets don’t always take them as prescribed, and 88 percent of people with severe asthma don’t use their inhalers as agreed with their healthcare professional. Does this sound familiar? Many people avoid using their inhalers because of worries about side effects. What do you think might be stopping you? How could you best let your healthcare professional know about your concerns?

This is important, because if you don’t take your medicine properly - and don’t tell your healthcare professional - they will see you with symptoms that haven’t improved and think they need to increase your dose of medicine, or add extra treatments in. So you could end up taking more medicine than you actually need. If you have any concerns about your medicine, the best thing to do is have an open conversation with your healthcare professional. It might feel a bit embarrassing or uncomfortable at first, but it can ease your worries, so you feel able to stick to your treatment plan and give your medicines the best chance to work as well as possible.

When you start treatment

Healthcare professionals start with the lowest level of treatment needed to manage your asthma, and work up until your symptoms are under some kind of control.

Someone with severe asthma will normally be taking at least four different types of medicine and will still have symptoms. The standard medicines you’ll be taking include:

  1. A reliever inhaler (usually blue). Everyone with asthma should have one of these. Your reliever inhaler opens your airways quickly to give on-the-spot relief when you have symptoms. It’s very important to keep it with you at all times.
  2. preventer inhaler, which contains corticosteroids to help reduce the inflammation and swelling in your airways and reduce your chance of reacting to triggers. You need to take this every day, as prescribed. Your healthcare professional may increase your dose to up to 2,000 micrograms per day.
  3. You will probably also be taking a long-acting beta agonist (LABA), which helps keep your airways open for around 12 hours – longer than your reliever inhaler - by relaxing the muscles around them.
  4. Your healthcare professional may add another medicine, such as a leukotriene receptor antagonist, slow-release theophylline, a long-acting muscarinic receptor antagonist (a LAMA) or a beta-2 agonist tablet.

If you're still experiencing symptoms or getting flare-ups of your asthma, or you need regular steroid tablets, you should be referred for assessment by a consultant at this stage. You’ll probably be taking all the medicines above but your healthcare professional may also add daily steroids in tablet form. These medicines have a proven track record of helping with asthma symptoms.

But many people are concerned about the potential side effects of steroids - especially people with severe asthma, because they usually have to take oral steroids at high doses to keep their asthma under control. The benefits of taking them as prescribed usually outweigh any disadvantages of potential side effects such as mood swings, or weight gain. The risks of not taking them when they’re needed include putting yourself at an increased risk of an asthma attack – so steroid tablets are an essential option at times for most people with severe asthma. If you are concerned about them, try making a list of pros and cons in your case.

Your healthcare professional will be well aware of the possible side effects of steroid tablets and will always monitor the doses and medicines you need for your asthma. To reduce the risk of side effects, they will keep you on the lowest possible dose of steroid tablets. In order to do this, they’ll keep prescribing your preventer inhaler at the maximum dose and they may also give you other treatments to help reduce the need for the tablets. All medicines prescribed to reduce the need for steroid tablets are known as ‘steroid-sparing treatments’.

Stay on the right treatment

If your symptoms have improved, you can ask them about reducing your medicines if they don’t mention it. The goal is always to make sure you’re on the lowest dose of medicines needed to manage your asthma and reduce your risk of having a potentially life-threatening asthma attack.

Before stepping down your treatment, your healthcare professional will consider:

  • what symptoms you’re getting, and how often
  • any side effects you’re experiencing
  • how long you’ve been taking your current treatment
  • how you’re feeling

Sometimes, people end up at a higher step of asthma treatment simply because they’re not using their medicines properly, or they have not had their inhaler technique checked to make sure they’re getting the most benefits from their medicines. So, before stepping up your treatment, your healthcare professional should make sure you’ve been:

  • taking your medicines as prescribed
  • using your inhalers correctly
  • managing your triggers as well as possible

Your healthcare professional should also check that you have a personal asthma action plan. 

“My consultant is really supportive. If I have any problems with my asthma, I know I can ask for help. They’ve changed my treatment plans and I’m finally on the right medication, which is making my asthma easier to manage. My consultant also keeps my GP informed. I’ve recently had problems with my sinuses again, which is flaring up my asthma, but my consultants are being really good and I am having appointments regularly to find out what’s going on.“ - Celena Dell, 34

What if standard asthma medicines don’t help?

For some people with severe asthma, even if they take high doses of the medicines lots of people with asthma take, it doesn’t help them get any measure of control over their symptoms. If this is the case for you, your healthcare professional may suggest you use a nebuliser at home when symptoms are particularly severe. This is a machine that delivers a high dose of medicine in a fine mist.

Your healthcare professional may also suggest you try a newer specialist treatment. These include a group of drugs known as monoclonal antibodies, including omalizumab, also known as Xolair, which has been shown to reduce the number of asthma attacks in people with severe allergic asthma. 

Mepolizumab, and Rezlizumab are other monoclonal antibody treatments, recommended by NICE as add-on therapies for adults with severe eosinophilic asthma. This is a type of severe asthma where the inflammation in the airways is linked to a particular type of white blood cell (the eosinophilic blood cell).

Bronchial thermoplasty, a surgical procedure, is another newer treatment that can help some people with severe asthma.

These newer treatments aren’t suitable for everyone, so if you’re wondering whether one of them might help you, speak to your specialist.

Remember, if you have any questions about your severe asthma, you can always call our Helpline on 0300 222 5800 (Mon - Fri; 9am - 5pm) and speak to one of our friendly asthma nurses. 

Last updated January 2017

Next review due January 2020