Severe Persistent Asthma Overview
People who suffer from severe persistent asthma usually experience asthma symptoms throughout the day on most days and have frequent symptoms at night, as well. These symptoms tend to limit one’s physical activity.
According to the National Guidelines for managing asthma, severity of asthma is classified as severe persistent according to the following factors:
- Frequency of symptoms (throughout the day)
- Frequency of nighttime awakenings with asthma symptoms (often daily)
- Use of a quick-relief inhaler (several time per day)
- How much asthma interferes with daily activities (extremely limited)
- Peak flow readings (less than 60% of personal best)
- Whether asthma flares require use or oral steroids (2 or more times a year)
Written by Vidhi Soni, MDShow All
Doctors Who Treat Severe Persistent Asthma
As your severe asthma is diagnosed, treated and managed, you may encounter the following doctors and specialists listed in this severe asthma patient education guide who can work in tandem as your asthma team.
- Family Physician – Doctor with a specialty in internal medicine. This is often a patient’s primary care physician who helps in the initial diagnosis and treatment.
- Allergist – An internist who has taken additional training as a specialist in allergy and immunology. An allergist specializes in allergies, asthma, and allergic asthma.
- Pulmonologist – A specialist in respiratory diseases. Some pulmonologists may get additional board certification in critical-care medicine.
- Emergency Physician – a physician who works at an emergency department to care for acutely ill patients. Patients with severe asthma may go to an emergency room when their symptoms escalate quickly and become severe.
How to Prepare for Your Severe Persistent Asthma Doctor Visit
Although you are suffering from severe asthma symptoms, it is very important to follow certain steps to get maximum benefit from your healthcare provider. In turn, it will help the doctor determine your severity of asthma or rule out any other possible condition. Read more in this severe asthma patient education guide.
- Write down all symptoms, including any other signs in the body unrelated to purpose of visit.
- Note down duration, specific time or triggering factors of your symptoms, if noticed
- Write down key personal information, including any stresses or recent life changes
- Make list of all medications, vitamins and supplements that you are taking. Include the dosage as well.
Questions to Ask Your Doctor About Severe Persistent Asthma
Below is a list of questions to discuss with your doctor so you can make informed decisions about your severe asthma issues.
Questions About My Diagnosis
- What are the diagnostic tests required for my condition?
- Why I have developed severe persistent asthma?
- What is the cause of severe asthma? What are the signs of emergency?
Questions About My Treatment
- Is severe persistent asthma treatable?
- Do I have to be on steroids for rest of my life?
- How do I use inhaler?
- What are the medications that I have to avoid?
- What are the side effects of medications prescribed? How we can avoid those side effects?
- What are the medications that I have to carry with me all the time?
Questions About My Lifestyle & Family
- Are there certain places or foods that need to be avoided?
- Are there lifestyle habits I can change to get some asthma relief and reduce my risk of an asthma attack?
- Is asthma hereditary? Can I pass it to my children?
- Will severe asthma symptoms affect my family and work?
Common Tests or Labs to Diagnose Severe Persistent Asthma
There are several tests and labs used to make a proper diagnosis and monitor your ongoing condition. Below are listed the most common severe persistent asthma tests and labs ordered, why you need them, and what they can tell you about your condition.
|Complete Blood Count||IgE and Eosinophils are antibodies. If asthma is due to an allergy, the level of these antibodies will be raised.||Regular blood test is performed; blood is drawn from venous puncture in arm||Eosinophil : 1-4%
IgE – 4.2-595 U/mL
|Sputum Sample||To rule out other chronic illness like Tuberculosis||Cough sputum into sterile specimen cup||May show casts of small airways, thick mucoid sputum|
|Pulmonary Function Tests||Measures the amount (volume) and/or speed (flow) of air that can be inhaled and exhaled in the lungs||The patient performs several hard breathes into a machine||Accurate measurement is dependent upon the patient’s performing the appropriate maneuver properly. Very difficult to perform in children.|
|Chest X-ray||Rules out any other cause of blockage/narrowing of the bronchi||This is a non-invasive test. A picture is taken of the chest and lungs.||Increased bronchial wall markings, associated with chronic inflammation and accessory muscle use.|
Common Medications and Treatments for Severe Persistent Asthma
Generally severe persistent asthma is treated with combination of asthma medications
Long Term Daily Control Medication
This line of treatment t reduces inflammation of the airways to prevent asthma symptoms and asthma attacks.
|Drug Category||How it Works|
|Inhaled Steroids||Acts directly in the breathing passage, one of the most common mode of treatment|
|Leukotriene Modifiers||Acts on chemical substances that promote inflammatory response during acute attack, orally taken|
|Long Acting Beta Agonists||Long acting bronchodilator. Keeps breathing passage open for more than 12hrs.|
|Immunodilators||Reduces inflammation by impacting a number of different places in the pathophysiology of asthma|
|Anti-IgE Therapy||Blocks IgE in your body and may help to relieve symptoms and control asthma. It is an injection given every 2 to 4 weeks, depending on your specific IgE level in the blood.|
Quick Relief Medications
This are fast acting relief from asthma symptoms, but relieves symptoms for shorter duration. It is highly recommended to keep doctor’s instruction in mind before using these medications.
|Drug Category||How it Works|
|Short-Acting Beta Agonists||Opens breathing passages in minutes. The effects usually last only 4 hours.|
|Anticholinergics||Takes slightly longer than beta-agonists to achieve an effect, but has longer lasting relief|