How can my mother manage severe asthma and COPD?

Question

Hello doctor,

My 67-year-old mom has severe asthma that developed into COPD from years of smoking, and now she can barely breathe even with all her medications. She quit smoking five years ago, but the damage was already done, and her lung function keeps getting worse.

She uses an Albuterol inhaler six to eight times daily, in addition to Advair twice a day, but still experiences constant wheezing. Her latest spirometry results showed an FEV1 of only 35 percent predicted, which the pulmonologist described as very severe.

She has been to the emergency room four times in the past two months for asthma attacks, and each time, they give her Prednisone, which helps temporarily but makes her blood sugar go crazy. She also has diabetes, and the steroids pushed her A1C up to 11.2 last time.

She tried Tiotropium, and it helped a little, but insurance stopped covering the brand she was using. She is now using nebulizer treatments four times daily with Albuterol and Ipratropium, but it is so time-consuming.

She cannot walk more than 20 feet without getting out of breath and needs oxygen at night. I am worried about her getting pneumonia because she has had it twice already this year.

What other treatment options exist for severe asthma with COPD?

Please help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I have gone through your query and understand your concern.

I am sorry your mother is going through this. An FEV1 (forced expiratory volume) of around 35 percent means her lungs have minimal reserve left, so constant wheezing, frequent rescue inhaler use, and repeated emergency visits are unfortunately common.

Using Albuterol many times a day and needing repeated Prednisone courses tells us that her current regimen is no longer enough. While steroids give temporary relief, repeated courses often worsen blood sugar control and, over time, can create more problems than they solve, especially in someone with diabetes (high blood sugar).

In patients like your mother, management usually needs to move beyond basic inhalers alone. Combining long-acting bronchodilators that work in different ways can significantly reduce breathlessness and flare-ups, even if lung function numbers do not improve much.

When asthma (a chronic lung disease where airways get inflamed) features remain active alongside COPD (chronic obstructive pulmonary disease, a progressive lung condition), some patients benefit from long-term anti-inflammatory treatments aimed at reducing attacks and steroid dependence rather than treating crises repeatedly. These decisions are individualized and based on how often exacerbations occur and how the patient responds over time.

Because she becomes breathless with minimal walking, pulmonary rehabilitation can be very important. This is a structured, supervised program that focuses on breathing efficiency, muscle conditioning, and pacing, not just exercise. Even when lung damage cannot be reversed, many patients regain meaningful day-to-day function and confidence through this approach.

Oxygen use should also be reassessed carefully to ensure she is receiving it when she truly needs it, including during activity if required.

Your concern about pneumonia (a lung infection that causes inflammation) is valid. Severe airflow disease, frequent steroid exposure, and prior infections all increase that risk. Reducing flare-ups, minimizing unnecessary steroid use, and maintaining consistent follow-up are key steps in lowering that risk going forward.

At this stage, care works best when guided closely by a pulmonologist experienced in managing severe asthma and COPD overlap, because minor adjustments often make a significant difference. While the underlying lung damage cannot be undone, many patients can still achieve better symptom control, fewer hospital visits, and a more stable quality of life with the right long-term strategy.

I hope I have answered your question.

Let me know if I can assist you further.

Thank you.