Ask the Allergist: When Asthma Turns Severe…



Q: I have been following my Asthma Action Plan and taking my preventive medications every day, but my asthma still bothers me on a daily basis. What more can I do? 

SilversWilliam S. Silvers, MD: First, if you find that you need your quick-relief bronchodilator inhaler more than twice a week, or if you’re having nighttime asthma symptoms more than twice a month, then your asthma is not well controlled.

You need to have an evaluation by a board-certified allergist and undergo the 5-question Asthma Control Test to determine the severity of your symptoms and if there’s a need for an increase in your controller maintenance medication. I also encourage you to use a peak flow meter, a portable handheld device that tracks airflow from your lungs.

Secondly, think about what is happening in your life that could be causing your asthma symptoms to worsen. Examine your lifestyle, including your diet, how much you exercise, how well you’re sleeping, and most importantly, stress management. What is stressing you in your life right now? We know that emotional stress can drive asthma symptoms.

Allergists will take a look at a patient’s overall lifestyle – in addition to evaluating environmental avoidances such as pollen, mold, pet dander or dust mites – before we consider stepping up or stepping down medications.

Once you’re prescribed medications, we have to consider how compliant you are with taking them, including whether you’re using correct inhaler technique. Some patients are reluctant to take their medication, perhaps because they are worried about side effects. Others tend to slack off on taking their medication when they start feeling better. So compliance is a very important part of a treatment plan.

If you’ve tried inhaled corticosteroids, long-acting beta-agonist bronchodilators and muscarinic antagonists (anticholinergics), and you’re still experiencing asthma symptoms, then biologics are the next step.

Biologics, administered as an injection or intravenously every 2-4 weeks, target the cells and pathways that cause bronchoconstriction and allergic inflammation. We get a window into the patient as an individual. Only a few biologics for asthma are available, but more are in the pipeline.

Patients with allergic asthma should also consider allergy immunotherapy, which can reduce the underlying trigger of asthma and decrease the severity of symptoms over time.


William S. Silvers, MD, FACAAI, is the founder of Allergy Asthma Colorado, P.C. in Denver and is a member of the Board of Regents with the American College of Allergy, Asthma & Immunology (ACAAI).


Have a medical question? Email editor@AllergyAsthmaNetwork.org or write to “Ask the Allergist,” Allergy & Asthma Network, 8229 Boone Blvd., Suite 260, Vienna, VA 22182.


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