Severe Asthma: Symptoms, Causes & Management

Severe asthma is a chronic inflammatory airway disease characterized by persistent symptoms and frequent exacerbations despite high‑dose inhaled corticosteroids (ICS) plus a second controller (e.g., LABA, LTRA, theophylline) or systemic corticosteroids.

Key Features:

• Daily symptoms: wheeze, cough, chest tightness, dyspnea.
• Nocturnal awakenings ≥1×/week.
• FEV₁ <60% predicted or >30% variability.
• ≥2 exacerbations/year requiring systemic steroids or hospitalization.

Management (per GINA guidelines):

1. Confirm diagnosis, adherence, inhaler technique, comorbidities (rhinitis, GERD, obesity).
2. Optimize high‑dose ICS‑LABA.
3. Add‑on therapies: LAMA (tiotropium), biologic agents (anti‑IgE, anti‑IL5/5R, anti‑IL4Rα, anti‑TSLP) for specific phenotypes.
4. Consider low‑dose maintenance oral corticosteroids as last resort.
5. Written action plan, regular review, vaccinations (flu, pneumococcal, COVID‑19).

Severe asthma requires specialist care (pulmonologist/allergist) to tailor biologic therapy and minimize steroid toxicity. Poor control can be life‑threatening.