Severe asthma does not respond well to regular asthma treatments, such as inhaled corticosteroids and inhaled bronchodilator medications.

Those with severe asthma usually find their symptoms difficult to control, making asthma attacks more dangerous. By working with a doctor, a person with severe asthma can find ways to manage their symptoms.

Beyond taking medications, it is important to learn to identify and avoid triggers and prevent and manage asthma attacks.

Brittle asthma

Brittle asthma is an older term for potentially life threatening and difficult-to-treat asthma. Healthcare professionals generally no longer use this term. Instead, they will describe asthma as severe or difficult to treat.

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Nearly 28 million people in the United States have asthma. Severe asthma is relatively uncommon, generally affecting 5% to 10% of those with asthma.

Healthcare professionals categorize asthma severity by how the symptoms respond to treatment. People with severe asthma find it difficult to manage their symptoms using typical medications.

Severe, persistent asthma involves symptoms that persist throughout the day and night. Asthma may interfere with daily activities and make sleeping difficult — nighttime symptoms often arise in people with severe asthma.

The Allergy and Asthma Network defines severe asthma — despite using standard treatments — as those who still require:

  • both high dose inhaled corticosteroids and long-acting beta-2 agonists or other controller medications
  • oral corticosteroids to prevent the asthma from becoming uncontrolled or that it remains uncontrolled despite therapy

When symptoms are harder to manage, a person may have a greater risk of asthma-related complications.

According to 2012 guidelines from the National Institutes of Health (NIH)Trusted Source, severe asthma has the following features:

  • symptoms that occur throughout the day
  • for those ages 5 and above, being woken up by symptoms, often 7 nights per week
  • for those ages 4 and younger, being woken up by symptoms more than 1 night per week
  • symptoms that require short-acting beta-2 agonist therapy several times per day
  • symptoms that significantly limit a person’s regular activities
  • for those ages 5 and above, a forced expiratory volume 1 (FEV 1) measurement of less than 60% of typical levels

FEV 1 refers to forced expiratory volume. It measures how much air a person can force from their lungs in 1 second. This can give a healthcare professional a better idea about their lung function.

Read about the different types of asthma.

People with asthma may experience the condition differently. For many, symptoms can be unpredictable. However, there are some typical symptoms and experiences.

Severe asthma can affect a person’s ability to perform usual daily tasks. Without effective treatment, symptoms can be debilitating.

Sometimes, symptoms can occur throughout the day and during the night, forcing the person to wake up.

Asthma symptoms can rangeTrusted Source in severity from minor inconveniences to life threatening attacks, during which symptoms worsen all at once.

Typical asthma symptoms

Symptoms of asthma include:

Learn more about the signs and symptoms of asthma.

Healthcare professionals diagnose severe asthma if regular treatments cannot manage the symptoms effectively.

This means that a diagnosis may take some time, and a person may have to try various treatments to see if they work.

Healthcare professionals use a three-stage processTrusted Source for diagnosing asthma:

They may also test for other conditions that have similar symptoms.

Read more about testing for asthma.

The focus of asthma treatment is to control the symptoms. This includes managing the underlying airway inflammation, minimizing the risk of future attacks, and preventing lung damage.

People with severe asthma generally need to take medications more frequently and in stronger dosages than those with mild asthma. Individuals need to speak with a healthcare professional to find out the best way to manage specific symptoms.

If a person has a severe asthma attack, they need to go to the hospital right away. Asthma attacks can be life threatening, especially when a person’s asthma does not respond well to treatment.

According to asthma experts, the best way to reduce the risk of severe attacks and uncontrolled symptoms is to avoid triggers as much as possible and take prescribed treatments.

Quick relief and long-term treatments are available.

Quick relief treatments

One type of quick relief asthma medication is selective short-acting beta-2 agonistsTrusted Source. A person takes this type of medication when asthma symptoms occur.

Examples of this class of drug include:

Long-term treatments

For long-term controller therapy, healthcare professionals may recommend daily drugs to prevent asthma flares. Inhaled corticosteroids are among the most effective long-term asthma medications.

Inhaled corticosteroids can have side effectsTrusted Source, including oral thrush, a yeast infection that develops in the mouth. To protect against thrush, a person needs to rinse their mouth after using the inhaler.

Asthma and allergy resources

To discover more evidence-based information and resources for living with asthma and allergies, visit our dedicated hub.

Asthma is a common condition affecting millions of people daily, and its severity varies.

While most cases of asthma respond well or adequately to treatment, severe asthma does not respond sufficiently to the usual treatment options.

People with severe asthma need to do their best to avoid triggers. Additionally, working with a healthcare professional will help identify the most effective treatments.