Severe Asthma ToolkitSevere Asthma Toolkit
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  • What is Severe Asthma?
    • Overview
    • Definition
    • Prevalence & Burden
    • Pathophysiology
    • Symptoms
    • Severe Asthma Attacks / Exacerbations / Flare-ups
    • Asthma Phenotypes
  • Diagnosis & Assessment
    • Overview
    • Diagnosis Overview
    • Assessment Overview
    • Lung Function Assessments
    • Questionnaires
    • Allergy Assessments
    • Phenotyping
    • Bronchoscopy
    • Imaging
    • Occupational Asthma
  • Management
    • Overview
    • Asthma Education
      • About Severe Asthma
      • Asthma Pathophysiology
      • Medications Education
      • Self-Monitoring
      • Triggers
      • Review
    • Written Action Plans
    • Adherence
    • Inhaler Technique
    • Physical Activity & Exercise
    • Interdisciplinary Approach & Multidimensional Assessment
    • Referral
  • Medications
    • Overview
    • Relievers
    • Preventers / Controllers
    • Add-on Therapies
    • Monoclonal Antibodies
      • Travelling with Monoclonal Antibodies
    • Bronchial Thermoplasty
  • Co-Morbidities
    • Overview
    • Pulmonary & Upper Airways
      • Allergic & Non-Allergic Rhinitis
      • Chronic Rhinosinusitis
      • Dysfunctional Breathing
      • Vocal Cord Dysfunction
      • Chronic Obstructive Pulmonary Disease
      • Bronchiectasis
      • Obstructive Sleep Apnoea
    • Extra-Pulmonary
      • Obesity
      • Anxiety & Depression
      • Gastro-oesophageal Reflux Disease (GORD)
      • Osteoporosis
      • Cardiovascular Disease & Metabolic Disease
  • Living with Severe Asthma
    • Overview
    • Daily Symptom Burden
    • Mental & Emotional Health
    • Intimacy & Relationships
    • Self-Management Support
    • Medication Use & Costs
    • Experience of Care
    • Experience of Asthma Attacks
    • Prognosis
  • Establishing a Clinic
    • Overview
    • Set-up
    • Staffing & Multidisciplinary Team Approach
    • Facilities
    • Delivery Approach
    • Tailored Referrals
    • Evaluation
    • Opportunities for Training & Research
    • Barriers & Hurdles
  • Paediatrics
    • Overview
    • Management in Paediatrics
    • Assessment in Paediatrics
    • Alternative Diagnosis & Co-Morbidities in Paediatrics
    • Psychosocial Issues in Paediatrics
    • Medications in Paediatrics
    • Asthma in the Adolescent Population
  • Resources
    • Overview
    • Clinic Recommendations
    • Infographics
    • Asthma Assessment Resources
    • Systematic & Multidimensional Assessment Resources
      • Airway Components
      • Comorbidity Components
      • Risk Factor Components
    • Translation & Implementation
    • Case Studies
    • Presentations
    • Videos
    • Relevant Links
    • Key References

Daily Symptom Burden

Home Living with Severe Asthma Daily Symptom Burden

Severe Asthma Symptoms

Severe asthma is associated with daily symptoms of shortness of breath, disturbed sleep, cough and wheeze, and frequent flare-ups, exacerbations or attacks. During flare-ups people experience sudden, unpredictable and often devastating worsening of symptoms, even when taking high doses of medication. For more information see Prevalence and Burden

“You wake up and you feel heavy”
Video provided by Associate Professor Lorraine Smith and Ms. Daniela Eassey, University of Sydney

Severe asthma interrupts daily lives, severely limiting activities. Severe asthma symptoms can be debilitating and can interfere with day-to-day living and the ability to work and/or study. Many people with severe asthma also report that their disease limits social and work relationships, career choice, travel and exercise. Symptoms can vary widely within a 24-hour period; which can also make assessment challenging.

“I can’t do certain things….can’t do really heavy work anymore…I get really tired really quickly if I do heavy work”
Video provided by Associate Professor Lorraine Smith and Ms. Daniela Eassey, University of Sydney.

Assessment of asthma symptoms is an important part of patient management. Increased symptom frequency and/or severity may warn of an impending exacerbation. There are two commonly used questionnaires that assess asthma control using symptom-experience based items – the Asthma Control Questionnaire (ACQ) and Asthma Control Test (ACT). Both were developed as a measure of asthma control in general asthma but are also frequently used to assess asthma control in people with severe asthma. For more information see Diagnosis – Questionnaires

“Tightness in your chest…huffing and puffing to get in enough air…the air is thick”
Video provided by Associate Professor Lorraine Smith and Ms. Daniela Eassey, University of Sydney.

Symptoms associated with asthma treatment

Treatments options for people with severe asthma are increasing, with the approvals of new biologics (e.g. omalizumab and mepolizumab). However, access to targeted therapies depends on accurate asthma diagnosis, referral to a specialist centre, phenotyping, and meeting clinical guidelines for approval.

High dose corticosteroids remain a main treatment option to reduce symptoms. Unfortunately, steroids cause toxic and debilitating side effects, especially if taken for long periods. The combination of asthma symptoms and symptoms associated with treatment increases disease burden. The often-complex combination of medications required to control severe asthma symptoms is also an ongoing physical reminder of the condition. For more information see Medications – Monoclonal Antibodies

At lower doses, inhaled steroids have few side effects. The most common include thrush and hoarseness, although this is rare. Patients should be encouraged to thoroughly rinse their mouth after using the asthma inhaler. Using a spacer device with metered dose inhalers can help prevent these side effects.

Side-effects of high doses of corticosteroids include:

  • Puffy face and swollen ankles
  • Mood swings – mania (euphoria, overexcited, hyperactive) to depression
  • Agitation, irritability
  • Adrenal insufficiency, causing weight loss and fatigue
  • High blood sugar, which can trigger or worsen diabetes
  • Increased risk of infections
  • Thinning bones (osteoporosis) and fractures
  • Thin skin, bruising and slower wound healing

People experiencing the above symptoms are likely to need support to manage symptoms and to ensure adherence is optimised and corticosteroid exposure is minimised, where possible.

Useful Links:

  • The Uncovering Asthma Report provides insight in a European population

  • Asthma + Lung UK – insights and stories from people living with severe asthma 
  • Reading on patients’ views of the burden of asthma (Goeman et al. 2002)
  • Asthma UK – Long-term Use of Corticosteroids
  • Mayo Clinic – Overview of Prednisone & Other Corticosteroids
  • People’s perspectives on taking corticosteroid therapy (Gamble et al. 2007)
  • Qualitative study of the impact of severe asthma and its treatments – (Hyland et al. 2015)
  • What is severe asthma? from Asthma Australia – provides insight into the impact of daily symptoms of severe asthma, patient information and resources.
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Last Updated on October 3, 2022

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  • Prognosis

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