There are different types of asthma. For most patients with mild asthma, it can be well controlled with low doses of maintenance inhaler therapy. For a small proportion of patients, asthma symptoms and attacks continue despite good adherence and correct inhaler technique with high dose inhaled maintenance therapy; this is called severe asthma severe asthma.
Severe Treatment-Refractory Asthma
A smaller number of the severe asthma patients are unable to control their asthma, despite good adherence and correct inhaler technique while taking high levels of inhaled medications and sometimes oral corticosteroids.
People with severe asthma have asthma symptoms most of the time. The disease causes frequent attacks requiring oral corticosteroids and may cause severe airflow limitation causing constant shortness of breath. People with severe treatment refractory asthma have frequent hospitalisations sometimes requiring intensive care management (Chung et al. 2014).
Asthma Symptom Control
The table below highlights differences between good and poor symptom control. Factors are usually assessed over the previous 4 weeks. Information about asthma control questionnaires are available under Diagnosis & Assessment – Questionnaires.
| Good symptom control | Poor symptom control |
| Daytime symptoms ≤2 days per week | Daytime symptoms >2 days per week |
| Need for reliever ≤2 days per week | Need for reliever >2 days per week |
| No limitation of activities | Any limitation of activities |
| No symptoms during night or on waking | Any symptoms during night or on waking |
- Discuss asthma symptom control with the patient – For most people with asthma, when they take inhaled medications correctly, their asthma symptoms are kept under control. However, for people with severe asthma, it is important to indicate that symptoms may remain despite adherence medication and the importance of continuing to take medications and regular review.
