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What is considered severe asthma?

Medically reviewed by Carmen Pope, BPharm. Last updated on Dec 13, 2023.

Official answer

by Drugs.com

Severe asthma is when you require medium to high-dose inhaled corticosteroids combined with other longer-acting medications. Severe asthma can also be defined as having a peak expiratory flow rate (PEF or PEFR) less than 50% of your personal best. This shows severe narrowing of your large airways and is considered a medical emergency and you should get help right away. Your symptoms may include coughing, being very short of breath, wheezing while breathing in and out, or retractions (this is when you can see the muscles between the ribs working hard to keep you breathing). Walking and talking may also be difficult.

References
  • Peak Flow Measurement. John Hopkins Medicine. 2021. https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/peak-flow-measurement
  • Camargo C, Rachelefsky, Schatz M. Managing Asthma Exacerbations in the Emergency Department. Summary of the National Asthma Education and Prevention Program Expert Panel Report 3 Guidelines for the Management of Asthma Exacerbations. Department of Emergency Medicine and Division of Rheumatology, Allergy, and Immunology, Department of Medicine https://www.atsjournals.org/doi/pdf/10.1513/pats.P09ST2#:~:text=The%20primary%20determinant%20of%20severity,The%20exacerbation%20severity%20determines%20treatment.

Read next

Severe and poorly controlled asthma can lead to damaged lungs which may increase the risk of developing chronic obstructive pulmonary disease (COPD). Symptoms of asthma and COPD may frequently co-exist in smokers and the elderly. Continue reading

Severe asthma is treated by using higher doses of inhaled corticosteroids or using inhaled corticosteroids more frequently; taking oral corticosteroids or being given corticosteroid injections; with continuous inhaled nebulizers; using ipratropium bromide aerosols; taking long-acting beta-agonists (LABAs) such as albuterol or formoterol, which help keep the airways open for about 12 hours; leukotriene receptor antagonists (LTRAs), such as montelukast or zafirlukast; slow-release theophylline; long-acting muscarinic receptor antagonists (LAMAs) such as tiotropium bromide or glycopyrronium bromide; with biologics such as omalizumab, mepolizumab, reslizumab, benralizumab, or dupilumab.

Continue reading

A peak expiratory flow rate (PEF or PEFR) is the single best determinant of asthma severity. A PEF measurement is a quick test to measure air flowing out of the lungs. During the test, you blow forcefully into the mouthpiece of a device, usually a peak flow meter (PFM), which is a portable, light, handheld device made of plastic. If the test is done in a healthcare provider's office or a hospital a much larger device, called a spirometer, is usually used. This device has a handheld mouthpiece that’s attached by a cord to a larger electronic machine. Continue reading

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