What Is Moderate-to-Severe Asthma?

This article is for people who are living with moderate-to-severe asthma and their care partners, or anyone who wants to learn more about asthma. The goal of this activity is to help you work with and talk to your doctor and healthcare team about ways to help manage asthma and the importance of asthma control.

You will learn about: 

• What asthma is and possible causes and risk factors 

• What asthma severity means, and why asthma control is important 

• Ways to help manage asthma in the long term and short term

• Questions you can ask your doctor and healthcare team  

Asthma is a chronic (long-term) condition where you have inflammation (swelling) that can narrow your airways and make it hard for you to breathe.

For some people, inflammation is triggered by exposure to a substance that causes an allergic reaction (an allergen). Common allergens include pollen, mold, dust mites, and animal saliva and dander. 

Other people can have non-allergic triggers, such as air pollution, cigarette smoke, exercise, cold air, or an infection. Sometimes, though, asthma symptoms can happen because of no known or identified trigger. 

It's not always known what causes asthma. But certain factors that may increase your chances can include:

• Allergies or allergic reactions

• A family history of asthma or allergies

• Living with certain other health conditions, such as rhinitis (chronic runny or stuffy nose), sinusitis (sinus inflammation), pneumonia (a lung infection), certain airway infections, obesity or overweight, and gastroesophageal reflux disease or GERD (heartburn)

Common asthma symptoms can include:

• Shortness of breath, wheezing, or trouble breathing 

• Cough that doesn't go away, gets worse with a cold or the flu, or happens during sleep, exercise, or in cold air

• Chest tightness or pain

• Fatigue (tiredness) or having less energy 

For some people, asthma symptoms can greatly impact their quality of life and be bad enough to interfere with their sleep and daily activities.

How bad, or severe, asthma is can often be defined by how frequently you have symptoms. 

With moderate asthma, symptoms happen every day with nighttime awakenings more than 1 night a week. Symptoms may disrupt your normal activities and make it hard for you to sleep. 

With severe asthma, symptoms happen throughout the day on most days with nighttime awakenings every night. Severe asthma can make it hard to talk or be active and even easy daily tasks can be difficult. It may also be hard to control symptoms.

Asthma, especially if not well-controlled, can greatly affect your quality of life and interfere with work, school, sleep, and daily activities. Severe uncontrolled asthma can even be debilitating.

Over time, asthma can cause serious complications (additional problems) such as:

• Permanent narrowing of your airways

• Lung damage and infections

• Missed work and activities

• Stress, anxiety, and depression

Asthma that's not managed properly can also result in asthma attacks that may lead to hospital or emergency room visits and can even be life-threatening.

There are ways to help manage asthma, and getting proper treatment can make a big difference in helping to control symptoms and prevent complications. 

You and your doctor can make a treatment plan together that best fits your individual needs, including any changes if your asthma changes. The goals of asthma treatment will be to prevent attacks and any damage, have long-term control, and improve your quality of life.

Ways to help manage asthma can include: 

• Identifying and avoiding any triggers when possible 

• Lifestyle changes, such as not smoking and finding ways to help cope with stress

• Medicines, including taking all medicines as directed and using inhalers correctly

To help control asthma symptoms and prevent attacks, types of long-term medicines -- typically taken daily -- that your doctor may recommend can include:

• Long-acting beta agonist (bronchodilator) inhalers 

• Inhaled corticosteroids, alone or in combination with a long-acting beta agonist 

• Leukotriene modifiers

• Biologics for moderate-to-severe or severe asthma that doesn't get better with other medicines 

Talk to your doctor in advance about what to do if you have an asthma attack. As part of your treatment plan, they may recommend quick-relief (rescue) medicines that are used as needed for short-term relief of symptoms. These can include short-acting beta agonist inhalers, anticholinergics (some of which may also be used to prevent symptoms), and corticosteroids for serious attacks.

All medicines can have side effects, and different medicines can have different ones. Different side effects may also happen over time with certain medicines. 

Ask your doctor or healthcare team member in advance about any side effects that may happen with the medicines in your treatment plan -- including those with long-term medicines and quick-relief medicines -- and how to manage them.

It's important to take all medicines and use all inhalers as directed. Don't stop or change any without talking to your doctor or healthcare team member first as this can affect your asthma control and may even lead to an attack.

Questions you can ask about asthma can include:

• What can I do to help control my asthma, and how will I know if it's controlled?

• Are there any triggers for my asthma? If so, how can I avoid them? 

• Are there any lifestyle changes I should make?

• What treatments are available, and what are their possible side effects? 

• What is the right way to take my medicines and use my inhalers? 

• What should I do if I start to feel stressed or have an asthma attack?

You have successfully completed the program What Is Moderate-to-Severe Asthma?

View Additional Materials on this topic that you may find useful:

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Manage Your Asthma: Know Your Triggers and Treatment Options

You Can Control Your Asthma

Learn How to Control Asthma