Severe asthma

Severe asthma represents a subset of asthma in which symptoms remain uncontrolled despite optimized inhaled therapies, adherence to treatment, and trigger avoidance. Patients with this condition often experience persistent wheezing, frequent exacerbations, nighttime symptoms, and limitations in daily activities. The underlying causes are multifactorial, including persistent airway inflammation, structural airway changes, comorbidities such as obesity or chronic rhinosinusitis, environmental exposures, and genetic predispositions. Comprehensive evaluation involves detailed clinical history, lung function testing, imaging to assess airway remodeling, and biomarker analysis to identify specific inflammatory pathways, allowing for precise classification of disease subtypes.

Management of severe asthma requires a multifaceted approach that combines advanced pharmacologic therapies with supportive care. Biologic treatments targeting IgE, interleukin-5, or interleukin-4/13 pathways have demonstrated efficacy in reducing exacerbations and improving lung function in patients with specific inflammatory phenotypes. Adjunctive medications, including long-acting bronchodilators and corticosteroid-sparing agents, help optimize symptom control. Non-pharmacologic interventions such as pulmonary rehabilitation, structured exercise, trigger avoidance, and environmental modifications complement medical therapy. Patient education regarding inhaler technique, early recognition of worsening symptoms, and adherence to therapy is essential. Multidisciplinary collaboration among pulmonologists, allergists, and respiratory therapists ensures personalized treatment planning. By integrating advanced therapies with lifestyle and educational interventions, patients with severe asthma can achieve improved symptom control, reduced hospitalizations, and enhanced long-term respiratory health.