How you should deal with severe asthma

Severe asthma can be life-threatening


Our bodies are finely tuned machines and need oxygen to produce energy. Atmospheric air enters our body through the airways. Upon reaching the lungs, the inhaled oxygen diffuses into the blood and is exchanged for carbon dioxide, which is thrown out of the body. The smooth running of the airways and other parts of the respiratory system is crucial for the process.

Patients with asthma, however, suffer from hypersensitive airways, which become inflamed and narrow when they encounter allergens like smoke, tobacco and pollen. Asthma-related inflammation results in symptoms, which vary from person to person, from one season to another, and at any time of the day. Some of the key symptoms that make it difficult for the patient to breathe include:

Wheezing―a high-pitched sound while breathing.

Coughing can be accompanied by mucus and worsens at night, disturbing sleep.

Tightness in the chest―a feeling that something is squeezing or sitting on one’s chest.

Breathlessness―inability to catch one’s breath or feeling out of breath.

Uncontrolled asthma can result in severe attacks, which can even lead to hospitalisation. Though it cannot be cured, doctors can help manage asthma symptoms with two types of inhaled medications―reliever inhalers that offer short-term instant relief, and maintenance inhalers that help prevent subsequent attacks.

In case asthma symptoms worsen or asthma attacks are more frequent in spite of treatment, it is essential to reach out to a respiratory specialist. These doctors may recommend other types of medications after assessing the patient.

Severe asthma can be life-threatening

Nearly 1.9 million Indian asthmatic patients suffer from severe asthma. In such patients, the symptoms persist even after they are treated with the highest possible dose of inhalers, and other modifiable factors that may interfere with control (such as triggers, coexisting conditions and inaccurate use of inhalers) are ruled out.

Though the symptoms remain the same, patients with severe asthma suffer from more intense episodes and often do not obtain instant relief from reliever medication. The unpredictability of the severe asthma symptoms interferes with day-to-day activities, considerably impacting the quality of life.

Severe asthma attacks can constitute a medical emergency and may require immediate hospitalisation. Life-threatening attacks can lead to:

◆ Lack of speech

◆ Chest tightness

◆ Loss of consciousness

◆ Exhaustion and confusion

◆ Extremely low levels of oxygen in the blood

◆ Death

Respiratory specialists diagnose severe asthma based on the patient’s symptoms, their frequency, and the need for hospitalisation due to flare-ups. They may also use specific tests such as pulmonary function tests (spirometry), peak flow meter and fraction of exhaled nitric oxide to confirm the diagnosis. Research has shown that the underlying inflammation patterns differ in patients with severe asthma, and it could be allergic, eosinophilic, or non-eosinophilic. The doctor may prescribe a simple blood test to confirm the type of severe asthma.

Severe asthma can be managed

With the advent of more specific therapies, doctors can manage severe asthma more successfully, providing patients with much-needed peace of mind to carry out their normal activities.

The doctor may also ask the patient to check their asthma control with the help of a simple questionnaire called the Asthma Control Test (ACT). If the patient’s score is less than 20, it is not well controlled. Those who suffer from unpredictable and persistent bouts of asthma must reach out to the doctor for a complete assessment.

Inhaled medication taken correctly is the backbone of asthma therapy, and any modification in treatment should be made in consultation with the doctor. Moreover, avoid going to places with bad air quality (especially during festivals) to reduce the aggravation of asthma symptoms.

The writer is an assistant professor in the department of pulmonary medicine, critical care medicine and sleep disorders, at Vardhman Mahavir Medical College & Safdarjung Hospital, Delhi.