Severe Asthma – Types and Treatments

Overview

 Asthma in its severe form can make breathing difficult, affect daily activities and diminish quality-of-life for the patient. In this article, we will understand what exactly is severe asthma, its types, their symptoms and treatment options.

Introduction

Asthma is a condition marked by severe inflammation of the airways in the lungs. The condition is quite common in India. According to estimates by WHO and National Family Health Survey (conducted by the Indian government), nearly3% (40 million patients) suffer from asthma. Out of these, adults are at 2.4% while children are between 4% to 20% depending on the age.

Types of Asthmas

There are various environment and internal/biological triggers for asthma. Environmental triggers include allergies and occupational hazards, while biological includes genetic reasons and respiratory infections. Allergies include air pollution, dust mites, pests, pets, tobacco smoke, household chemicals and certain food-smells. Occupational exposure includes cleaning products, flour dust, sawdust and industrial chemicals. Exercise can also be a trigger for some people.

However, not all asthmas are severe. For most people, the condition can be kept under control using a combination of quick-relief (short-term) medication and controller (long-term) medicines. To make it easy for patients, their families and caregivers to avail the right kind of care, the medical fraternity over the years has classified asthma into different types.

• occupational asthma (related to the job, so a job-change can help)
• allergic (atopic or extrinsic) asthma
• non-allergic (non-atopic or intrinsic) asthma
• child-onset and adult-onset asthma
• exercise-induced asthma (also called exercise-induced bronchoconstriction)

Classification of Severity

– Mild
– Moderate
– Severe

The Mild and Moderate Asthma can be managed with inhalers.

Severe Asthma

Persistent asthma is one in which the symptoms show up often and last a long duration. The condition can be mild, moderate or severe. Of these, severe persistent asthma is the least common type. Symptoms include:

• Shortness of breath, tightness in the chest and cough that occur all through the day, every day
• The person is kept awake at night by the symptoms, almost every day of the week
• There is severe disruption in one’s academic, professional and personal lives
• Quick-relief medication must be used again and again

Asthma Exacerbation

In this, the symptoms are so sudden and acute, these episodes are called asthma attacks. The person doesn’t respond to regular treatment. In some cases, the attack may be fatal. Symptoms of this type include:

• Shortness of breath that is severe, and the chest feels tight
• There is wheezing accompanied by a bluish tinge to the lips
• Difficulty in speaking: the person can’t speak full sentences
• The person feels breathless even when lying down
• The person feels that sitting or standing up will make breathing easier
• The person hunches his/her shoulders, leading to muscle strain in the stomach and neck
• Cognitive impairment: person feels confused, cannot concentrate and is agitated

Treatment for Severe Asthma

• Inhalers containing high dose inhaled corticosteroids and bronchodilators
• Macrolide Antibiotics: These medicines control the number of neutrophils which is a type of white blood cells found in the airways. High counts of neutrophils in blood or sputum samples have been associated with asthma episodes. So, asthmatics are given these on a short-term basis but it’s not advised for long-term treatment due to side-effects such as antibiotic resistance which can get serious.
• Oral Corticosteroids: These medicines control inflammation and are given to asthmatics in the short-term although some patients with repeated asthma episodes may also be prescribed this. For patients with severe persistent asthma, these medicines are given along with quick-relief medicine, long-acting bronchodilators and high-dose inhaled corticosteroids. There are side-effects such as organ damage but the benefits outweigh the risks for asthmatics. These are given cautiously and in small doses.
• Biologics or Monoclonal Antibodies: These block inflammatory response to airway triggers by targeting specific cells. These medicines are given as an injection in the doctor’s office, an IV infusion at a hospital or self-injection by the patient at home. Every course lasts 2-8 weeks depending on which is the drug given, and may be repeated if required.

Treatment for exacerbation/attacks:

• Short-acting beta agonists: These medicines are the same as those used in quick-acting inhalers given in an emergency. Examples include albuterol. These medications are administered using a special machine called nebulizer which will turn the drug into a mist that is inhaled deep into the lungs.
• Oral corticosteroids: As mentioned before, these drugs help reduce inflammation in the lungs and bring asthma symptoms under control. They are given as oral pills. However, for patients who are experiencing vomiting or respiratory failure, these can be given intravenously.
• Ipratropium: When albuterol, mentioned earlier, is not very effective, the patient is given Ipratropium that acts as a bronchodilator and brings the asthma attack under control.
• Intubation, mechanical ventilation and oxygen: If the asthma attack is life-threatening, this method will be used. The doctors will insert a breathing tube down the throat and into the upper airway. Then, using another machine, oxygen is pumped into the lungs to enable breathing. At the same time, the doctor will administer some medication to bring the asthma under control.

 

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Reviewed by Dr Suresh S Venkita, Group Medical Director, Kauvery Hospitals

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NOTE: Take medications only when prescribed by your doctors, self-medication must be avoided under any circumstances.

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Kauvery Hospital is globally known for its multidisciplinary services at all its Centers of Excellence, and for its comprehensive, Avant-Grade technology, especially in diagnostics and remedial care in heart diseases, transplantation, vascular and neurosciences medicine. Located in the heart of Trichy (Tennur, Royal Road and Alexandria Road (Cantonment), Chennai, Hosur, Salem and Bengaluru, the hospital also renders adult and pediatric trauma care.

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