Uncontrolled asthma generally improves with the right treatment. With severe asthma, symptoms can be more persistent, even with treatment.

Asthma is a chronic condition of the lungs. The airways become inflamed and narrow at times, making it difficult to breathe. In the United States, asthma affects about 20.2 million adults and 4.6 million children.

If you have uncontrolled asthma, you may experience symptoms such as coughing, shortness of breath, and chest tightness every day. And an asthma attack could become life threatening.

Uncontrolled asthma symptoms often improve with adjustments to your treatment plan. If you have severe asthma, however, you may continue to experience daily symptoms and frequent flare-ups even if you’re taking high dose quick-relief medications and long-term controller medications.

This article answers common questions about severe versus uncontrolled asthma and what you can expect from treatment.

If your asthma is well managed, you may have mild symptoms or perhaps none at all. You may not have major asthma attacks or emergencies and may seldom need to use quick-relief medications. You may still experience flare-ups, but in general, well-managed asthma doesn’t interfere with daily activities.

Signs of uncontrolled asthma include:

  • having symptoms just about every day
  • having flare-ups that wake you from sleep two or more times a month
  • needing quick-relief medication more than twice a week
  • frequent trips to the emergency room for asthma symptoms
  • being unable to work or perform other daily activities due to your symptoms

Your asthma doesn’t necessarily have to be severe to be considered uncontrolled. You may have mild or moderate asthma with uncontrolled symptoms.

Uncontrolled asthma can often improve with changes to your treatment plan. These changes may include adding:

  • a high dose inhaled corticosteroid
  • an additional long-term controller medication
  • an oral corticosteroid

If your asthma symptoms don’t respond to treatment after 3–6 months despite taking the highest dose of inhaled corticosteroid plus a second long-term controller medication or an oral corticosteroid, your doctor may diagnose you with severe asthma.

Severe asthma affects up to 10% of adults and 2.5% of children with asthma. And it isn’t necessarily uncontrolled. It means that despite following an optimal treatment plan, you still have frequent symptoms that affect your daily life.

There are three types of severe asthma:

  • allergic asthma
  • eosinophilic asthma
  • non-eosinophilic asthma

Your doctor can help you develop a personalized treatment plan based on the type of severe asthma you have.

Uncontrolled asthma can cause major disruptions to work, school, and social activities. It can hamper your ability to function and impact your quality of life. It usually means frequent use of rescue medications and doctor visits, along with a higher likelihood of emergency room visits and hospitalizations.

Uncontrolled asthma can cause complications such as:

  • feeling tired and unable to perform well
  • stress, anxiety, depression
  • pneumonia
  • delays in growth or puberty in children with asthma
  • potentially life threatening severe asthma attacks

Asthma can flare up due to common triggers, such as:

  • respiratory infections
  • exercise
  • strong emotions
  • stress
  • pollen
  • animal dander
  • fragrances
  • smoke
  • extreme temperatures
  • certain medications

Avoiding or managing these triggers may help prevent some flare-ups. If you’re not certain what’s causing your symptoms, talk with your doctor. They may recommend allergy testing to help identify potential triggers.

It can also help to address other contributing factors and comorbidities, such as:

  • smoking
  • sleep apnea
  • gastroesophageal reflux disease (GERD), a condition in which stomach acids move up into the esophagus
  • cardiac disease
  • obesity
  • depression
  • anxiety

Your doctor may also want to confirm the diagnosis of asthma or diagnose coexisting conditions, which may require blood and lung function tests.

One potential cause of uncontrolled mild or moderate asthma is not taking medications as prescribed. Speak with your doctor if you’re having trouble following the instructions or can’t access the medications. Following your treatment plan will help your doctor evaluate how well it works and if it’s time to try something else.

Your treatment plan may include quick-relief medications such as short-acting inhaled bronchodilators that help you breathe better. Daily medications for long-term control may include:

  • anticholinergics
  • low dose, medium dose, or high dose inhaled corticosteroids
  • inhaled long-acting beta-agonists
  • leukotriene receptor agonists
  • oral corticosteroids
  • injections or sublingual (under the tongue) tablets for known allergies

Medications known as biologics can help treat severe uncontrolled asthma by reducing flare-ups. Biologics work by targeting molecules involved in the airway inflammation that leads to asthma symptoms. Blood tests can help determine which would be most effective for you.

These medications include:

  • benralizumab (Fasenra)
  • dupilumab (Dupixent)
  • mepolizumab (Nucala)
  • omalizumab (Xolair)
  • reslizumab (Cinqair)
  • tezepelumab-ekko (Tezspire)

Some are administered by injection just under the skin (subcutaneous), and others require intravenous (IV) infusion.

If you have been diagnosed with severe asthma, you’ll need a personalized treatment plan. This may involve seeing specialists, such as:

  • an allergist
  • an otolaryngologist (ear, nose, and throat doctor)
  • a pulmonologist (lung specialist)

Treatment may include a combination of therapies such as:

  • inhaled or oral corticosteroids
  • short-acting and long-acting beta-agonists
  • anticholinergics
  • leukotriene receptor antagonists
  • allergy shots (immunotherapy)
  • biologics

You should also seek treatment for other health conditions that can worsen your asthma.

A severe asthma attack can be life threatening. Learn the warning signs and know what to do in case of an emergency. It can help to put together an asthma action plan for quick reference. Items to include are:

  • a list of daily medications, plus how and when to take them
  • a list of rescue medications and instructions
  • contact information for doctors, pharmacists, and other healthcare professionals

Anyone with asthma should see a doctor at least once a year or as recommended. But don’t wait until your regularly scheduled appointment if you have signs of uncontrolled or severe asthma. See a doctor as soon as possible if you have worsening symptoms such as:

  • weakness
  • dizziness
  • persistent cough
  • wheezing, especially if it gets worse despite using quick-relief medicines
  • frequent flare-ups
  • trouble breathing or shortness of breath that doesn’t get better with quick-relief medications

You may also see your doctor if it feels like asthma is taking over your life and you’re feeling scared or frustrated or if you’ve been diagnosed with another condition that affects your asthma

According to the American Lung Association, signs that you need emergency care include:

  • taking 30 or more breaths per minute
  • lips or nails turning blue
  • difficulty talking or walking at your normal pace
  • your nostrils flare when you breathe in, and the skin between your ribs or at the base of the throat looks stretched with every breath

Daily symptoms, nighttime flare-ups, and frequent use of rescue medications are potential signs of uncontrolled asthma. Asthma doesn’t have to be severe to be uncontrolled. Most of the time, you can bring asthma under control with the right treatment plan and some lifestyle adjustments.

With severe asthma, you might continue to have symptoms even when you follow a treatment plan that includes the highest dose of inhaled corticosteroids plus a second long-term controller medication or an oral corticosteroid. But medications can still help reduce flare-ups and make symptoms more manageable.

If your asthma symptoms are worsening or your treatment doesn’t seem to be working, see your doctor as soon as possible.