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Severe asthma is asthma that is the most difficult to control so, although it can be treated, it can take time to find a combination of medicines that work.
In recent years more people with severe asthma are being treated with biologic therapies. These have had good results but are not suitable for all people with severe asthma.
New biologics are being tested and developed, so in future it is hoped most people with severe asthma will be offered a biologics therapy to bring their severe asthma under control.
Having open and honest discussions with your healthcare professional about your asthma and medication will help get the right treatment for you.
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.
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.
“Taking your medicines as agreed with your healthcare professional is crucial,” says Dr Andy Whittamore, Asthma UK's in-house GP. “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. Otherwise your healthcare professional may think you need more medicines or higher doses that really aren’t necessary.”
Many people avoid using their inhalers because of worries about side effects. If you have concerns about your medicines that are stopping you taking them as prescribed, let your healthcare professional know.
“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.”
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 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.
- 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.
Your healthcare professional will work with you to see how well your symptoms are controlled, and add on other 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.
These add on treatments 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 are 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 having asthma attacks, 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.
Taking steroids long term can cause side effects and many people have concerns about them. Your healthcare professional will keep the steroid dose as low as possible, but without them people with severe asthma risk having a life-threatening asthma attack.
“Many people may be concerned about the potential side effects of these higher doses of steroids long term,” says Dr Andy. “Steroid tablets are an essential option at times for most people with severe asthma. Your healthcare professional will make sure you are on the lowest possible dose, 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.’
Taking high doses of inhaled corticosteroids can temporarily affect your body’s ability to produce its own corticosteroids. These natural chemicals help our bodies deal with illness or infection, or cope with the stress of surgery.
If you're on a high dose of steroids (either as tablets or in your inhaler) you should be given a steroid card from your GP.
This is a card that lets health care professionals know you take steroids. It is useful in emergency situations, as your body may not produce enough natural steroids to help you deal with illness or injury. In this situation, doctors will need to give you extra corticosteroids.
Make sure you always carry your steroid card with you. If you lose it, you can get a replacement from your pharmacy or GP.
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.
Do not stop steroids suddenly
If you’ve been prescribed steroids, whether as tablets, liquid or in an inhaler, make sure you take them every day as prescribed. Do not stop taking your steroid medication suddenly unless you have been told to by your GP or asthma nurse.
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:
- biologic therapies, also known as monoclonal antibodies (mAbs). These are a more recent treatment for people with certain types of severe asthma. They are only given at specialist treatment centres.
- bronchial thermoplasty, a surgical procedure that can help some people with severe asthma.
These treatments aren’t suitable for everyone, so if you’re wondering whether one of them might help you, speak to your specialist.
“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.
- 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 Andy. “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.”
Never stop taking your steroid medicines suddenly. Always speak to your GP or healthcare professional first.
Remember, if you have any questions about your severe asthma treatments, you can always call our Helpline on 0300 222 5800 (Monday-Friday, 9am-5pm) and speak to one of our friendly respiratory nurse specialists.