How to manage severe asthma?

Question

Hello doctor,

My asthma has been getting out of control lately, and I do not know why. I am 36 years old, have been using my inhaler more than usual, and have had to go to the emergency room (ER) twice this month for attacks. It is getting hard to do normal things, even walking up stairs. I follow my medicines, but I still feel like my lungs are not working right. Could something be triggering this? I used to have it under control, but now I feel like I am losing the battle. Should I be on a stronger inhaler or something else? I am worried about long-term lung damage.

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query and can understand your concern.

It sounds like your asthma is severely uncontrolled, and you need a treatment reassessment. Frequent inhaler use, emergency room (ER) visits, and difficulty with daily activities are signs that your current medications are not enough.

The possible reasons for your asthma worsening:

Increased airway inflammation – Asthma can change over time, requiring stronger anti-inflammatory treatment.
Undiagnosed triggers – Have you had any recent allergies, respiratory infections, weather changes, or new exposures (like mold, pets, or chemicals)?
Medication resistance – Overuse of short-acting inhalers (Albuterol/Salbutamol (bronchodilators)) can make them less effective over time.
Silent reflux (GERD) – Gastroesophageal reflux disease often worsens asthma by triggering lung irritation.
Eosinophilic or severe asthma variant – Some types of asthma need biologics (like Dupixent (interleukin inhibitors), Tezspire (thymic stromal lymphopoietin blocker), or Nucala (interleukin inhibitors)) instead of just inhalers.

The next steps for better control:

Ask about a stronger controller inhaler – You may need a higher-dose ICS/LABA (inhaled corticosteroid and long acting beta agonists) combined medicine like Breo (Fluticasone furoate and Vilanterol), Advair (Fluticasone propionate and Salmeterol), or Symbicort (Budesonide and Formoterol) or even a triple-therapy inhaler like Trelegy (Fluticasone, Umeclidinium, and Vilanterol).
Consider a biologic if standard inhalers are not enough – Based on your history, a specialist might suggest a biologic if your asthma is eosinophilic or allergic-driven.
Peak flow monitoring – Tracking your lung function at home can help predict worsening asthma before attacks happen.
Allergy or trigger testing – A pulmonologist can help pinpoint any hidden causes.
Pulmonary function Test (PFT) or FeNO (fractional exhaled nitric oxide) test) – This checks if inflammation is high and if your current medicines are effective.

Kindly consult a specialist doctor, talk with them, and take medications with their consent.

I hope this helps.

Thank you.