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severe asthma symptoms

Severe Asthma Symptoms

Symptoms of asthma can vary over time and between individuals.

Typical symptoms include:

  • Breathlessness
  • A tight feeling in the chest
  • Wheezing
  • Cough

Symptoms are:

  • Commonly worse at night or in the early morning
  • May be triggered by a specific agent (e.g. allergen, exercise or respiratory infection) or
  • By non-specific factors such as weather changes or irritants such as air pollution.

When asthma is well-controlled, individuals should experience few asthma symptoms. However, by definition, symptoms in people with severe asthma remain uncontrolled despite optimal treatment, or can only be well-controlled while high dose treatment is sustained.

People with severe asthma experience ongoing symptoms. In Australia, about 45% of adults with a diagnosis of asthma have frequent symptoms (this is 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).

types of severe asthma attack symptoms, types of severe asthma symptoms

Data represented from (Reddel et al. 2015)

People with severe asthma experience the same symptoms as people with mild or moderate asthma, but they may be more intense and/or more frequent.

Features that increase or decrease the probability that respiratory symptoms are due to asthma.

Symptom feature Asthma less likely as the cause of the symptoms Asthma more likely as the cause of the symptoms Specific features in severe asthma
Types of symptoms Only one out of wheezing, breathlessness, chest tightness or cough

Associated with dizziness or tingling of fingers

Cough with purulent sputum

Children who have cough only during the day

 More than one out of wheezing, breathlessness, chest tightness or cough Breathlessness on exercise may be very prominent in patients with severe asthma who are older or who have persistent airway obstruction
Location of symptoms Symptoms felt in upper chest or throat. However, children may not be able to localise the symptoms Across mid or lower chest. Children may not be able to localise the symptoms No specific features in severe asthma
Pattern over time Symptoms occur every day in a child or young adult

In children, symptoms start from soon after birth

 Symptoms vary over time, and vary in intensity

Symptoms occur episodically

 As asthma becomes more severe, or the patient becomes older, symptoms may become more persistent and less variable
Triggers Symptoms are mainly triggered by stress, strong smells or talking Symptoms are worse during the night or on waking

Symptoms mainly occur with exercise, cold air, laughter, allergens (if sensitised), colds/flu

 Patients with severe asthma may also have inducible laryngeal obstruction (also called vocal cord dysfunction (VCD)) as a comorbidity (Christensen et al. 2015, Low et al. 2011)
Response to exercise Symptoms decrease rapidly after the patient stops exercising Symptoms and bronchoconstriction worsen in the minutes after the patient stops exercising

Exercise-induced symptoms are prevented by warm-up or pre-exercise salbutamol

 Patients may tend to avoid exercise to avoid symptoms

Patients with severe asthma may be short of breath due to persistent airway obstruction rather than exercise-induced bronchoconstriction
Physical examination during symptoms Wheezing is mainly inspiratory or is accompanied by stridor or changed voice

Wheezing is unilateral

 Wheezing is mainly expiratory If airway obstruction is severe, wheezing may also occur on inspiration or may be absent
Response to treatment Lack of short-term response to bronchodilator or inhaled corticosteroids (ICS) suggests that symptoms are not due to asthma but does not rule out asthma Improvement in symptoms and lung function within 1-5 min of administration of salbutamol or other blue reliever inhaler

Symptoms decrease markedly within days to weeks after starting ICS

Symptoms worsen after ICS are stopped

 Patients with severe or long-standing asthma may develop persistent airway obstruction, with no bronchodilator reversibility

It is important to clarify the cause of symptoms before stepping up asthma treatment

Some patients with long-standing or severe asthma have persistent airflow limitation which is no longer reversible with bronchodilators. These patients may have persistent shortness of breath on exertion.

For patients with severe asthma, respiratory symptoms may be worsened by side-effects of oral corticosteroid treatment, because of weight gain or development of kyphoscoliosis due to osteoporosis; both of these can add to breathlessness. For more information see Living with Severe Asthma: Daily Symptom Burden

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