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Severe asthma is a lung disease that does not respond well to typical asthma treatments. It can become serious and even life-threatening if left untreated. Asthma is commonly triggered by allergens such as dust, pets, and cleaning products, and some less common triggers like weather changes and emotional distress.
This article outlines a list of asthma triggers, the symptoms to look for in a severe asthma attack, and how severe asthma is diagnosed and treated in a hospital setting.
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What Are the Symptoms of a Severe Asthma Attack?
Asthma is known as a progressive disease, meaning that it starts out with mild symptoms but can become severe over time. It is caused by inflammation or swelling of the airways, making it difficult for air to pass through.
The symptoms of severe asthma can vary from person to person, but the following signs could indicate a severe asthma attack:
- Coughing, especially in the morning and at night
- Tightness in the chest
- Shortness of breath
- Wheezing
- Difficulty talking
- Blue lips or fingernails
- Feeling confused or agitated
- Symptoms that do not improve with medication
Asthma attacks are typically treated by quick-relief medications that a person will breathe in through a device called a rescue inhaler. If asthma symptoms do not improve with the use of this or other medications, it could be a sign that asthma is severe.
Prevalence of Severe Asthma
Although severe asthma accounts for less than 10% of people with asthma, there are more than 500,000 hospitalizations for severe asthma attacks in the United States every year.
What Causes a Severe Asthma Attack?
Severe asthma attacks typically occur when an individual is exposed to an allergen. It's important to remember that different people have different triggers, so making a plan to identify yours can help reduce the frequency of severe asthma attacks.
The most common allergens that trigger asthma attacks include:
- Tobacco smoke: According to the Centers for Disease Control and Prevention (CDC), 1 in 5 people who have asthma smoke, despite the fact that tobacco smoke is known to trigger asthma attacks. Passive smoke, often referred to as secondhand smoke, can also exacerbate asthma symptoms.
- Dust mites: Specifically the dust mite's gut is thought to contain digestive enzymes that can trigger asthma symptoms.
- Air pollution: Air pollution is one of the most challenging triggers to avoid, since there is no way for an individual to control the air around them. However, using maintenance therapies can help reduce the risk of asthma attacks due to air pollution.
- Pests: Pests include creatures like cockroaches or rodents. These types of allergens are typically found in urban-area homes and can be minimized by keeping the home clean to avoid attracting these unwanted guests.
- Pets: Not to be confused with "pests", pets can trigger asthma attacks in some people. The most common household pets are cats and dogs, with cats being more allergenic than dogs.
- Mold: Molds found both inside and outside can contribute to asthma symptoms. Mold is typically found in damp areas, so identifying spaces in and out of the home that may develop mold can help you avoid mold-triggered asthma attacks.
- Cleaning and disinfectant products: These common household items can trigger asthma attacks. The Environmental Protection Agency (EPA) has a "Safer Choice" program that can help you choose safer products for you and your family.
People with severe asthma are at a greater risk for having asthma attacks on a regular basis. Severe asthma may not respond well to regular asthma treatment, so it is crucial to identify your own triggers and try to avoid them.
Less Common Triggers
The triggers listed above are the most typical, but there are many less common triggers that might also induce a severe asthma attack. Cold and flu, sinus issues, strenuous exercise, weather changes (especially cold weather), as well as stress and emotional distress can all affect asthma symptoms.
How Is a Severe Asthma Attack Diagnosed?
A healthcare provider will perform a lung function test to determine the severity of your asthma. There are different types of lung function tests using different types of devices to measure your airflow, including:
- Spirometry: During a spirometry test, the patient will breathe into a tube that is attached to a laptop or a machine called a spirometer. As you breathe, the spirometer will measure how much and how fast air goes in and out. You can expect your provider to do this test before and after you take a medication to open up your airways, called a bronchodilator, to see if there is improvement with medication.
- Peak expiratory flow (PEF): Peak flow measures the amount of air you can forcefully exhale. This form of measurement is helpful in monitoring severity, but is not used for diagnosing asthma.
- Fractional exhaled nitric oxide (FeNo): Asthma causes the lungs to become inflamed and produces a substance called nitric oxide. This test measures the amount of nitric oxide to determine how much inflammation is in the lungs.
- Provocation: During a provocation test, a healthcare provider will introduce different allergens to see how your body reacts and how you respond when medication is administered.
How Is a Severe Asthma Attack Treated at the Hospital?
If you experience difficulty breathing that does not improve with at-home treatment, seek medical attention.
Asthma treatment at the hospital could include typical at-home asthma medications combined with additional treatments such as supplemental oxygen, bronchodilators, and corticosteroids.
Some cases of asthma are so severe that a healthcare provider could recommend a procedure called bronchial thermoplasty that uses heat to soften the airways that constrict during an asthma attack.
The length of hospitalization can vary from person to person. Some people with severe asthma are treated in the emergency room but never admitted to the hospital. Regardless of admission, anyone who is treated at a hospital will be sent home with instructions on how to treat their asthma at home.
Discharge instructions following an asthma attack will advise the patient to avoid allergy triggers and follow up with their provider to adjust the asthma plan as needed. The instructions could also include additional medications, such as oral corticosteroids, to treat and prevent future attacks.
Summary
Severe asthma is serious and can be life-threatening. It's recommended that people with asthma work with their healthcare provider to identify their triggers and avoid them when possible. If triggers can't be avoided or a severe asthma attack comes on, there are treatment options available, which may require hospitalization.
A Word From Verywell
Asthma can greatly impact a person's quality of life, especially if it is severe. You can help yourself cope with severe asthma by being proactive. Make an asthma plan with your healthcare provider to identify triggers and minimize the risk of an asthma attack. An effective treatment plan can help you live well with the disease.
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