How is severe asthma treated and managed?

If you have severe asthma, your usual asthma treatments are not enough on their own. You’ll need specialist medicines too. Your specialist team will work with you to find the right treatments to help you manage your symptoms.

They’ll let you know if you need to lower the dose of your usual asthma inhalers. They may also tell you to reduce or stop taking any of your usual add-on medicines.

Your specialist team will need to support you to come off taking steroid tablets safely, if you’ve been taking these. 

It’s important to come off steroids slowly to avoid adrenal insufficiency. This is when your adrenal glands stop working properly. 

Coming off steroids safely and slowly is known as steroid weaning. This gives your adrenal glands a chance to start working properly again.

Biologic treatments

Biologic treatments treat inflammation in your airways by targeting the part of the immune system which causes the inflammation.

Depending on the type of severe asthma you have, you may benefit from these treatments.  Biologic therapies can be life-changing for some people with severe asthma.

Biologics can help you avoid taking high doses of steroid tablets long-term, which can have serious side effects.

If you’re eligible for biologics, your specialists will help you decide which one is right for you.

If you’re not suitable for biologics, your healthcare professional can look again at all the things that could be making your asthma worse. They can support you with good inhaler technique, keeping to your medicines routine, and avoiding triggers.

They may want to do some more tests or consider an add-on therapy like montelukast, if you haven’t tried one already.

Find out more about biologic treatments.

Steroid tablets

You may be given a short course of steroid tablets (usually prednisolone) if you have worsening symptoms or an asthma attack.

But taking steroid tablets for a long time means a higher risk of serious side effects like diabetes, osteoporosis, or adrenal insufficiency.

Because of this, healthcare professionals will only prescribe long term steroid tablets if other treatments are not suitable.

You may need long term steroid tablets if you’re not eligible for biologics and if all other treatments have been tried first.

Antibiotics

Studies suggest that some people with severe asthma may benefit from treatment with antibiotics called macrolides, including people taking biologics.

Research has found that if you have severe asthma, a type of antibiotics called macrolide antibiotics can:

• reduce the risk of asthma attacks
• improve symptom control
• improve quality of life.  

Nebulisers

Some people with severe asthma are prescribed nebuliser medicines to use at home. Nebulisers can give higher doses of medicines than inhalers.

If you use it to treat an asthma attack at home, you should still also get medical help.

Find out more about nebulisers.

1. Take your medicines at the same time every day.
2. Set yourself reminders – use an app on your phone.
3. Keep all your medicines in the same place.
4. Keep the boxes and patient information leaflets with your medicines so it’s easy to check on side effects or the use by dates.
5. Keep a copy of your asthma action plan with your medicines.
6. Use a dosette box. This is a tablet box with sections so you can add any tablets you need to take for each day of the week.
7. Set up repeat prescriptions.

If you have severe asthma, you may find yourself dealing with asthma symptoms most days. Often people with severe asthma have other health conditions to manage as well.

Your healthcare professional can talk to you about the best way to track your symptoms. This could be keeping a symptom diary, or recording your peak flow. You could try using an app.

Tracking symptoms can help you and your healthcare professional:

• recognise when your symptoms are getting worse, so you know to follow your  asthma action plan or seek urgent help
• know what triggers your asthma, like pollution, cigarette smoke, or allergies
• help you answer any questions about your symptoms at your next appointment
• see how your severe asthma is, and how treatments are working. 

It’s helpful to track any good days too, and worth getting into a good routine of noting your symptoms every day, maybe last thing at night.’ Dr Andy Whittamore, GP. 

Living with severe asthma can affect your work, relationships and mental wellbeing. We know that people with severe asthma often feel misunderstood as their condition can limit their activity a lot more than someone living with asthma.

It’s important to keep to a good routine of taking your asthma medicines every day and going to regular reviews with your healthcare professional. 

But there are lots of other things you can do to keep yourself and your lungs as healthy as possible.

Keep active

Find out more about keeping active with a lung condition including information about pulmonary rehabilitation, and Keep Active videos to help you get active at a pace that suits you. 

Quit smoking

Find out more about how giving up smoking helps your lung condition and the best ways to quit. Over time, smoking increases your risk of getting other lung conditions such as COPD.

Keep to a healthy weight

Eating well, staying active and keeping to a healthy weight can help your symptoms.

Find out more about keeping to a healthy weight with a lung condition.

Get your vaccines

Vaccines like the flu vaccine, COVID booster and the RSV vaccine can protect you from serious illness and complications from flu or COVID. Ask your doctor about the one-off pneumonia vaccine.

Look after your mental health and wellbeing

Living with a long term condition like severe asthma can be hard. People can sometimes feel anxious or depressed, especially if they have lots of asthma attacks or need emergency treatment in hospital.

Managing your condition well can help you feel more in control and more positive. It can help to focus on the things you can do, and to do things you enjoy.

It can help to talk to someone you trust about how your feeling. Your specialist team can support you with your mental health and wellbeing too.

Join a lung health support group

We also have some great online sessions you can join to support your lung health, including body breathing, mindfulness, singing, harmonica, and Zumba.

How do I sign up?

It’s easy to sign up by filling in a short online form. Just click the link for the session you’re interested in. Once you’re registered the support group team will email you a joining link.

Find out more about all our support groups and how to get started. Or you can email supportgroups@asthmaandlung.org.uk