Severe Asthma ToolkitSevere Asthma Toolkit
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  • What is Severe Asthma?
    • Overview
    • Definition
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      • About Severe Asthma
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      • Obesity
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  • Living with Severe Asthma
    • Overview
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    • Experience of Care
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    • Overview
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  • 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
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      • Airway Components
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Overview

Home Severe Asthma Overview
what is severe asthma intro infographic

Severe Asthma is Asthma that remains...

Uncontrolled...
Despite treatable factors having been addressed...
And maximal inhaled therapy being taken regularly
Uncontrolled...
  • Poor symptom control
  • Frequent severe exacerbations / flare-ups / attacks
  • Serious exacerbations (e.g. hospitalisation, ICU stay or mechanical ventilation)
  • Airflow limitation or
  • Controlled asthma that worsens on tapering of corticosteroid treatment
Despite treatable factors having been addressed...
  • Treatment adherence
  • Inhaler device technique
  • Self-monitoring
  • Trigger avoidance
  • Comorbidities identified and managed
And maximal inhaled therapy being taken regularly
  • High-dose inhaled corticosteroids (ICS) (e.g. beclomethasone >1000, budesonide >800) AND
  • Long-acting beta agonists (LABA) or other controller

How Common is Severe Asthma?

It is estimated that between 3-10% of people with asthma have severe disease. Severe asthma is serious problem and a major concern. Severe asthma puts a very heavy burden on individuals and their families (Foster et al. 2017) and on the health system (Sadatsafavi et al. 2010). For more information see the Prevalence & Burden section.

what is severe asthma infographic
high intensity treatment infographic
what is severe asthma and How Common is Severe Asthma?
  • High intensity treatment (cumulative total 23.5% of all asthma patients).
  • Difficult to treat asthma = poor asthma control + high intensity treatment (cumulative total 17.4% of all asthma patients).
  • Severe refractory asthma = poor asthma control + high intensity treatment + good adherence + correct inhaler technique (3.7% of all asthma patients)

Figure based on data from the Netherlands (Hekking et al. 2015)

LAY OVERVIEW

Not all asthma is the same. Around 3-10% of people with asthma have severe disease. People with severe asthma have symptoms and attacks even when taking high-dose medication. Severe asthma has a major impact on their lives. Symptoms include difficulty breathing, wheezing and coughing. Asthma attacks can lead to hospitalisation and even death. Severe asthma also has an emotional burden. People with severe asthma have high rates of anxiety and depression. Severe asthma also has a major cost on society. Severe asthma reduces people’s ability to work and is a major healthcare cost.

Some Facts About Severe Asthma

Defining the terms
Symptoms
Attacks / Exacerbations / Flare-ups
Phenotypes
Pathophysiology
Defining the terms

Not all asthma is the same. Most people with asthma experience mild to moderate symptoms, and respond well to standard preventer therapies. Some people continue to experience poor symptom control or attacks/flare-ups, despite being prescribed maximum doses of preventer medication. For many of these patients, this is because of problems that may be addressed, this is termed ‘difficult-to-treat asthma’. When these factors are managed effectively, some people continue to have frequent symptoms or frequent attacks/flare-ups. This is called ‘severe asthma’ or ‘severe treatment-refractory asthma’.

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Symptoms

People with severe asthma experience ongoing symptoms. In Australia, about 45% of adults with a diagnosis of asthma have frequent symptoms (called poor symptom control), and about one quarter need to have an urgent visit to their doctor or to a hospital in a year, because of their asthma (Reddel et al. 2015).

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Attacks / Exacerbations / Flare-ups

People with severe asthma experience frequent worsening of symptoms, termed attacks, flare-ups or exacerbations, which can lead to hospitalisation or even death.

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Phenotypes

Asthma differs between individuals due to different underlying disease mechanisms. Identifying the disease mechanisms that are active in an individual patient can be predictive of responses to targeted therapy.

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Pathophysiology

Key features of severe asthma pathology include airway inflammation, airway hyper-responsiveness, airway remodelling and mucous hypersecretion.

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info-graphic about Severe Asthma Pathophysiology, Healthy airway and what is severe asthma

Key Points

  • Asthma is a long-term breathing problem that affects about 1 in 9 Australians, causing wheezing, shortness of breath, chest tightness and cough. It can be controlled but not cured.
  • Almost half of people with asthma in Australia have uncontrolled asthma symptoms, and one quarter need urgent health care for asthma in a year.
  • Most asthma can be well-controlled if inhaled preventer treatment is taken regularly and correctly, but about 3-10% of people with asthma have frequent symptoms or attacks/flare-ups despite doing this. This is called severe.
  • Severe asthma puts a very heavy burden on patients, their families, and the health system.
  • There are different types of asthma, that despite having similar symptoms, are caused by different underlying mechanisms. These are particularly important in severe asthma, because they may indicate potential response to new biologic therapies.
Read more
Click here to download a printable version of the infographic below.

Access the full suite of infographics here.

severe asthma definition infographic

Last Updated on September 19, 2019

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  • Overview
  • Definition
  • Prevalence & Burden
  • Pathophysiology
  • Symptoms
  • Severe Asthma Attacks / Exacerbations / Flare-ups
  • Asthma Phenotypes

What is Severe Asthma?

It is asthma that remains uncontrolled despite treatable factors having been addressed and maximal inhaled therapy being taken regularly.

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