Young woman having asthma attack. She is holding asthma inhaler.

Severe asthma: definition, symptoms, causes, diagnosis and treatment

By Cristiano Antonino Last updated May 13, 2023

Severe asthma, also known as severe asthma, refers to that form of bronchial asthma that does not respond to high-dose therapy

It is a condition that compromises the sufferer’s quality of life, with symptom instability and, often, flare-ups that may necessitate recourse to systemic steroid therapy.

Between 3.5% and 10% of asthma sufferers are affected by severe asthma, but thanks to multidisciplinary care and monoclonal biological therapies, it is now possible to have good symptom control and a normal daily routine.

Severe asthma: symptoms and risk factors

Severe asthma sufferers develop symptoms that include a strong sense of chest constriction, difficulty breathing and limited lung function.

This is a condition that should not be underestimated, as it can also be life-threatening and force patients to have to go to the emergency room or be hospitalised to resolve more severe crises.

However, even today we still see little information and awareness among the population about the life-threatening nature of severe asthma.

Severe asthma can be related to a variety of triggers

allergies
physical exertion
cigarette smoking
climate change

It is also possible that severe asthma is related to an overactive immune system, which causes inflammation and narrowing of the airways.

Severe asthma: the multidisciplinary approach is essential

In short, severe asthma should not be underestimated and it is important to be taken care of by specialised centres that propose a multidisciplinary approach and personalised medicine.

It is precisely the multidisciplinary approach, which involves various specialist figures such as the pulmonologist, allergist or otorhinolaryngologist, that is fundamental to the management of the pathology: this approach allows the rapid identification of both the type of asthma (phenotype) from which the patient suffers, and the individual destabilising elements that make it severe and uncontrollable.

These include, for example, nasal polyposis, an association that is often found with bronchial asthma and in the case of which, therefore, the otolaryngologist will be fundamental.

Another example is allergic asthma, in which allergies are predominant in the clinical picture and imply the intervention of the allergy specialist.

Severe asthma, how monoclonal biological therapy works

In recent decades, science has made great strides in the treatment of severe forms of asthma.

In certain patients, unresponsive to high-dose inhalation therapy, with impaired quality of life and frequent respiratory crises, it is possible to start treatment with biological drugs, i.e. monoclonal antibodies, which act directly on the immune system, inhibiting the mechanisms underlying the maintenance and degeneration of severe asthma.

This is a subcutaneous therapy that is initially administered in hospital but can subsequently be carried out at home, with a frequency that varies from one administration every 14 days to one every 8 weeks, depending on the type of drug chosen.

Asthma is a chronic disease and, therefore, a complete cure is not possible.

However, biological therapy allows us to control symptoms to such an extent that the number of exacerbations is greatly reduced, and has a positive effect on quality of life and the reduction of symptoms, which are less impactful, to the point where we can achieve what is called clinical remission.

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