Asthma can be unpredictable and can limit many aspects of your life from physical activity to work, school, and time spent with friends and family.
Patients with severe asthma experience frequent symptoms such as coughing, wheezing, shortness of breath, chest tightness, mucus production, and exacerbations (asthma attacks) caused by a narrowing of the lungs’ airways.
Asthma is one of the top five chronic diseases globally, along with heart disease, stroke, cancer and diabetes1. It affects an estimated 300 million people worldwide, and this is expected to grow to as many as 400-500 million people by 20252,3. In Australia and New Zealand, approximately 10% of people diagnosed with asthma have severe asthma, described as having symptoms that occur throughout the day on most days and during the night.
Causes and Risk Factors
Causes of asthma are not fully understood, although risk factors appear to be a combination of genetics as well as exposure to other factors, such as:
- Indoor allergens (e.g. house dust mites in bedding, carpets and stuffed furniture; pollution and pet dander)4
- Outdoor allergens (e.g. pollens and moulds)5
- Tobacco smoke5
- Chemical irritants in the workplace5
- Air pollution5
- Cold air
- Extreme emotions such as anger or fear
- Physical exercise
- Certain medications (e.g. aspirin and other non-steroid anti-inflammatory drugs, or beta-blockers which are used to treat high blood pressure, heart conditions and migraine).
1. WHO. Asthma Fact sheet N°307. May 2011. Available at:
http://www.who.int/mediacentre/factsheets/fs307/en/index.html (accessed April 2014).
2. European Federation of Allergy and Airway Diseases Patients Association. Asthma. Available at: http://www.efanet.org/asthma/ (accessed April 2014).
3. The International Study of Asthma and Allergies in Childhood (ISAAC) Steering Committee. Worldwide variations in the prevalence of asthma symptoms: the International Study of Asthma and Allergies in Childhood (ISAAC). Eur Respir J 1998;12:315-35.
4. The International Study of Asthma and Allergies in Childhood (ISAAC) Steering Committee. Worldwide variations in the prevalence of asthma symptoms: the International Study of Asthma and Allergies in Childhood (ISAAC). Eur Respir J 1998;12:315-35.
Many drugs can be prescribed to manage asthma symptoms. Inhaled corticosteroids are the key drugs used for controlling the underlying inflammation in asthma, while bronchodilators widen the airways by relaxing airway smooth muscle, though they do not reverse airway inflammation.
Studies of people with severe asthma suggest that symptoms are poorly controlled5, even if people take their medications as prescribed (which another study showed that only about 50% did6).
Side effects from higher doses and longer treatment with corticosteroids may include suppression of the immune system, adrenal system, and growth; osteoporosis; skin thinning; hypertension; cataracts; glaucoma; muscle weakness; and increased risk of infection. Short-term side effects include stomach upset, headache, dizziness, trouble sleeping, fluid retention, weight gain, high blood pressure, loss of potassium, elevation of cholesterol levels and vision changes.
Side effects from higher doses and longer treatment with bronchodilators include rapid heartbeat, skeletal muscle tremor, potassium deficiency, increased lactic acid, headache and hyperglycemia. Long-acting beta-agonists may even cause severe asthma symptoms in some patients.
Bronchial Thermoplasty (BT)
BT is a revolutionary, non-drug approach to treating patients with severe asthma who are on high doses of medication and still have symptoms. BT actually reduces the amount of excess smooth-muscle tissue in the airways — the airways constrict less, breathing is easier, and there is less likelihood of an asthma attack.
After a 1 year clinical study7, patients treated with BT experienced a 32% decrease in asthma attacks, an 84% reduction on asthma-related emergency room visits, 66% fewer days lost from work, school and daily activities. 79% of patients reported a significant improvement in their quality of life, and these findings extended through a 5 year follow up period8.
You may be eligible for BT if you are 18 years or older with severe asthma, AND you have asthma symptoms despite taking inhaled corticosteroids and long-acting beta-agonists such as Seretide™, Dulera™, or Symbicort™. Contact your treating physician for advice, and note that BT is only performed by a specially trained pulmonologist.
5. Partridge MR. Examining the unmet need in adults with severe asthma. Eur Respir Rev. 2007;16:104,67-72.
6. GINA (Global Initiative for Asthma) 2012. Global Strategy for Asthma Management and Prevention. Workshop report in collaboration with National Institutes of Health (NIH) National Heart, Lung, and Blood Institute NHLB/WHO 2007.
7. Castro M, et al. Ann Allergy Asthma Immunol. 2011;107:65-70
8. Castro M, et al, for the AIR2 Trial Study Group. Am J Respir Crit Care Med. 2010;181:116-124
Bronchial Thermoplasty (BT), a Revolutionary Non-Drug Treatment for Severe Asthma
Learn how much your asthma affects your quality of life