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 treated?
There’s no doubt that severe asthma is harder to manage but it may be reassuring to know that 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 usually need to take higher doses of those medicines and you may also need extra medicines or newer treatments now available for some people with severe asthma.
It can take time to find the combination of treatments that works for you. In an Asthma UK survey, 41% 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.
Dealing with severe asthma: being honest with your healthcare professional is key
“While it can seem unfair that you have to take lots of medicine compared with most people with asthma, remember that these treatments could be saving you from having a potentially life-threatening asthma attack,” says Dr Andy Whittamore, in-house GP for Asthma UK. “And severe asthma can change over time so you may be advised by your healthcare professional to take different medicines or different doses depending on your symptoms, triggers and written asthma action plan.”
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 them is crucial,” says Dr Whittamore. “But we know that some people do not take all their medications regularly as prescribed. It’s important that you’re honest about how you use your medicines or else your healthcare professionals may think you require more medicines or higher doses that really aren’t needed.”
Research shows that at least 30% of people with severe asthma don’t take their steroid tablets as prescribed. As many as 88% of people with severe asthma might not be taking their inhalers as agreed with their healthcare professionals. 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?
“It might feel a bit embarrassing or uncomfortable at first,” says Dr Andy. “But it can ease your worries, or allow your healthcare professional to adjust your medicines, so you feel able to stick to your treatment plan and stay well.”
Severe asthma treatments you are likely to need
Healthcare professionals will usually start you on asthma medicines at the lowest dose possible to manage your symptoms. People with severe asthma may be prescribed the same medicines as people without severe asthma, but often at higher doses. So, you will be prescribed:
- 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.
- A preventer inhaler, which contains corticosteroids to help reduce the inflammation and swelling in your airways and lessen your chance of reacting to triggers. You need to take this every day, as prescribed.
Your healthcare professional will work with you to see how well your symptoms are controlled or not, and then add in other kinds of treatments if needed. You will work together to find a combination of treatments at the right doses to get your symptoms as well controlled as possible. This could include:
- Long-acting bronchodilators (LABAs), which help keep your airways open for about 12 hours – longer than your reliever inhaler – by relaxing the muscles around them. These would usually be prescribed in the same inhaler as the corticosteroid preventer.
- Other medicines such as leukotriene receptor antagonists (LTRAs), slow-release theophylline, beta-2 agonist tablets or long-acting muscarinic receptor antagonists (LAMAs).
If you’re still experiencing symptoms or getting flare-ups of your asthma, you are likely to be prescribed:
- Daily steroids in tablet or liquid form at higher doses and for longer periods of time than someone without severe asthma would usually take them. These are anti-inflammatory medicines to help reduce the sensitivity in your airways so they are less likely to react to triggers. If you are taking steroid tablets or liquid two or more times per year, or for long periods of time, you should be referred to an asthma specialist.
“Many people may be concerned about the potential side effects of these higher doses of steroids long term,” says Dr Andy Whittamore. If you have severe asthma the benefits of taking daily steroids as prescribed usually outweigh any disadvantages of potential side effects such as mood swings or weight gain. “This is because the risk of not taking them include more asthma attacks, which can be potentially life-threatening,” says Dr Whittamore. “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 make sure you are on the lowest possible dose,” says Dr Whittamore. “This is to keep your asthma symptoms as well controlled as possible but keep your risk of side effects as low as possible too.” In order to do this, they’ll keep prescribing your other preventer medication at high doses and they may also give you other treatments to help reduce the need for the steroid tablets. All medicines prescribed to reduce the need for steroid tablets are known as ‘steroid-sparing treatments.’
Severe asthma: what happens if steroid tablets don’t help?
If you need regular steroid tablets, but your symptoms are still not under control, or if your asthma symptoms can only be controlled by high-dose preventer inhalers or regular steroid tablet use, you should be referred for assessment by a consultant at a specialist asthma clinic. There may be a long waiting time so you need to work with your GP until you can get a specialist appointment.
At a specialist clinic, you may be advised to test different treatments to see if they help manage your severe asthma. These can be used along with your existing routine or in an adjusted combination of treatments for you. You may be offered:
- A newer kind of medicine for people with certain types of severe asthma, known as a monoclonal antibodies. These include omalizumab (Xolair), mepolizumab(Nucala), reslizumab (Cinquaero) and benralizumab (Fasenra).
- Bronchial thermoplasty, a surgical procedure 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.
Severe asthma: adjusting your treatments when symptoms change
“As your symptoms are likely to change over time, your healthcare professional will work with you to change your treatments to meet your needs,” says Dr Andy Whittamore.
- If your symptoms have improved for 12 weeks, you can ask your healthcare professional about reducing your medicines. They will review what symptoms you’re getting and how often, any side effects, how long you’ve been taking your current treatment and how you’re feeling now. 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.
- If your symptoms aren’t improving much, it is important to ask for support. “It may be that you need a change in the medicines or their dose,” says Dr Whittamore. “Or it could be as simple as helping you to remember to take your medicine, improving how you take your inhalers or even finding an inhaler that suits you better. Using an inhaler correctly improves how useful the medicines are in helping your asthma and reduces the chances of side effects.” You can also talk about ways to manage triggers and update your written asthma action plan.
“My consultant is really supportive and keeps my GP informed. 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. I’ve recently had problems with my sinuses again, which is aggravating my asthma, but I’m having appointments regularly to find out what’s going on.” – Celena Dell, 34
Remember, if you have any questions about your severe asthma, you can always call our Helpline on 0300 222 5800 (Monday-Friday, 9am-5pm) and speak to one of our friendly asthma nurses.
Last updated March 2019
Next review due March 2022