persistent severe asthma

Persistent Severe Asthma: A Comprehensive Overview

Persistent severe asthma is a type of asthma that is characterized by symptoms that persist throughout the day and night, significantly impacting daily life. This condition affects approximately 5% to 10% of all asthma sufferers [6][7].

The symptoms of persistent severe asthma can include:

• Chronic and recurrent cough
• Wheezing
• Shortness of breath
• Chest tightness or pressure
• Straining of the neck and chest muscles

These symptoms can be mild, moderate, or severe in nature and may occur more than twice a week, impacting daily activities [4][5].

Key Features

• Symptoms persist throughout the day and night
• Asthma interferes with daily life
• Long-term treatment is necessary to manage symptoms
• Poor treatment adherence and/or persistent triggers can contribute to severe asthma [8]

Treatment and Management

The basic treatment for severe persistent asthma consists of inhaled corticosteroids, which are often used in combination with other long-term controller medicines such as long-acting beta 2 agonists [1].

It's essential to note that moderate persistent asthma is classified if symptoms occur daily, with flare-ups lasting several days, and may include coughing and wheezing [2].

Persistent Severe Asthma Signs and Symptoms

Asthma can be classified into four stages based on its severity, with persistent severe asthma being the most critical form. The signs and symptoms of persistent severe asthma are often more pronounced and frequent compared to other forms of asthma.

• Chronic Coughing: A persistent cough that won't stop or worsens over time is a hallmark symptom of persistent severe asthma [6].
• Severe Wheezing: Wheezing, which is a high-pitched whistling sound while breathing out, can be extremely loud and persistent in individuals with severe asthma [9].
• Difficulty Breathing: Shortness of breath, chest tightness or pain, and difficulty talking are common symptoms of persistent severe asthma [5][11].
• Rapid Breathing: Very quick or rapid breathing is another symptom that may indicate persistent severe asthma [6].
• Pale, Sweaty Face: A pale, sweaty face can be a sign of severe respiratory distress in individuals with persistent severe asthma [1].

Additional Symptoms

Other symptoms associated with persistent severe asthma include:

• Chest tightness or pressure
• Straining of neck and chest muscles
• Chronic and recurrent coughing
• Wheezing
• Shortness of breath

It's essential to note that these symptoms can vary in severity and frequency from person to person. If you're experiencing any of these symptoms, it's crucial to consult with a healthcare professional for proper diagnosis and treatment.

References: [1] - Context result 1 [5] - Context result 5 [6] - Context result 6 [9] - Context result 9 [11] - Context result 11

Diagnosing Persistent Severe Asthma

Persistent severe asthma requires a comprehensive diagnostic approach to confirm the condition and rule out other possible causes. Here are some key tests used in diagnosing persistent severe asthma:

• Spirometry: This is the most common test for assessing lung function, which can help diagnose asthma (4). Spirometry measures how much air you can breathe in and out, and how quickly you can do so.
• Challenge Tests: These tests are designed to trigger symptoms of asthma and measure lung function before and after exposure to a specific stimulus. Challenge tests can help confirm an asthma diagnosis (2).
• Peak Flow Measurement: This test measures the maximum rate at which you can breathe out, which can indicate how well your lungs are functioning.
• Physical Exam: A physical exam by a healthcare professional is essential in diagnosing persistent severe asthma. They will assess symptoms and perform a physical examination to rule out other possible conditions (3).
• Lung Function Tests: These tests measure lung function and can help diagnose asthma. Lung function tests may include spirometry, peak flow measurement, and other assessments.
• Blood Tests: Blood tests may be ordered to rule out other conditions that may cause similar symptoms.

Additional Diagnostic Tools

• FeNo Testing: This test measures the level of exhaled nitric oxide in your breath, which can indicate inflammation in the airways (7).
• Methacholine Challenge Test: This test involves inhaling a medication that can trigger symptoms of asthma and measure lung function before and after exposure.

References

1. To diagnose asthma, your doctor will ask about your medical history and do a physical exam. You may need lung function tests, X-rays, or blood tests.
2. Apr 17, 2024 — Lung function tests and challenge tests can help confirm an asthma diagnosis. Learn more about asthma diagnostic tests.
3. Apr 6, 2024 — Your doctor will perform a physical exam to rule out other possible conditions, such as a respiratory infection or chronic obstructive ...
4. May 11, 2023 — Spirometry is the most common. It's a simple, quick, and painless way to check your lungs and airways.
5. Lung Procedures, Tests ... The specialist will review your medical history, your current asthma treatment plan and do a physical exam to assess your symptoms.
6. Two commonly performed tests for diagnosing and evaluating asthma are spirometry and peak flow measurement.
7. Learn "How is Asthma Diagnosed" through patient history, physical exam and other tests such as FeNo testing and the Methacholine challenge test.
8. by M Lommatzsch · 2014 · Cited by 181 — Allergy testing (skin prick test and/or measurement of allergen-specific IgE antibodies) are part of standard assessment.

Note: The information provided is based on the search results and may not be comprehensive or up-to-date. It's essential to consult a healthcare professional for accurate diagnosis and treatment.

Treatment Options for Severe Persistent Asthma

Severe persistent asthma requires more intensive treatment to manage symptoms and prevent exacerbations. The primary goal of treatment is to control inflammation, reduce symptoms, and improve quality of life.

• Inhaled Corticosteroids (ICS): High-dose ICS are the cornerstone of treatment for severe persistent asthma. They work by reducing airway inflammation and preventing symptoms [1].
• Long-Acting Beta Agonists (LABA): LABAs are often added to ICS to enhance control and prevent exacerbations. They can be administered via separate inhalers or a single inhaler containing both drugs [5].
• Biologic Medications: Six biologic medications have been approved by the FDA for treating severe uncontrolled asthma, including reslizumab, mepolizumab, omalizumab, benralizumab, dupilumab, and tezepelumab-ekko [3].
• Omalizumab: This monoclonal antibody is used as adjunctive therapy for patients aged 12 years or older with allergies. It works by preventing the binding of IgE to high-affinity receptors on basophils and mast cells [4].

Additional Treatment Options

For some patients, additional treatment options may be considered:

• Oral Corticosteroids: Oral corticosteroids are used to treat acute asthma flares and can be prescribed for short periods (5-7 days) [9].
• Combination Inhalers: Combination inhalers containing ICS and LABA can provide better control and prevention of symptoms in patients with severe persistent asthma [2].

Monitoring and Follow-up

Close monitoring of blood concentration is essential when using certain medications, such as omalizumab. Regular follow-up appointments with healthcare providers are also crucial to adjust treatment plans and ensure optimal control of symptoms.

References:

[1] The LAMA tiotropium (Spiriva Respimat) may be added to the treatment plan for severe asthma. [2] The review focuses on the ICS/LABA ... for the treatment of moderate to severe persistent asthma. [3] November 21, 2022 - There are currently six biologic drugs approved by the Food and Drug Administration for use in treating severe uncontrolled asthma. [4] Omalizumab (anti-IgE) is a monoclonal antibody that prevents binding of IgE to the high-affinity receptors on basophils and mast cells. [5] LABA is recommended in combination with ICS for long-term control and prevention of symptoms in patients aged 5 years or older who have moderate or severe persistent asthma.

Persistent Severe Asthma Differential Diagnoses

Asthma can be challenging to diagnose, especially when symptoms persist or worsen over time. In such cases, it's essential to consider differential diagnoses that may mimic or exacerbate asthma symptoms. Here are some conditions that should be ruled out in patients with persistent severe asthma:

• Chronic Obstructive Pulmonary Disease (COPD): COPD is a progressive lung disease characterized by airflow limitation, often caused by smoking or exposure to pollutants. Symptoms can include chronic cough, wheezing, and shortness of breath [9].
• Allergic or Non-Allergic Rhinitis: Upper airway inflammation can lead to symptoms like nasal congestion, sneezing, and postnasal drip, which may be mistaken for asthma [9].
• Gastro-Oesophageal Reflux Disease (GERD): GERD can cause chronic cough, wheezing, and shortness of breath due to stomach acid reflux into the lungs [9].
• Post-Nasal Drip: Excess mucus production in the nasal passages can lead to symptoms like coughing, sneezing, and congestion, which may be mistaken for asthma [9].
• Vocal Cord Dysfunction or Inducible Laryngeal Obstruction (ILO): Abnormal vocal cord movement can cause respiratory symptoms similar to asthma, such as shortness of breath and wheezing [2].
• Tracheal and Bronchial Lesions: Structural abnormalities in the airways can lead to chronic cough, wheezing, and shortness of breath, which may be mistaken for asthma [2].
• Foreign Bodies: Inhaled foreign objects or substances can cause respiratory symptoms similar to asthma, such as coughing, wheezing, and shortness of breath [2].

Diagnostic Considerations

When diagnosing persistent severe asthma, it's crucial to consider these differential diagnoses. A thorough medical history, physical examination, and diagnostic tests (e.g., spirometry, imaging studies) can help rule out these conditions.

• Clubbing, Cyanosis, Significant Anemia, or Nasal Polyps: Presence of these symptoms may indicate a need to reconsider the diagnosis of asthma [3].
• Uncommon Asthma Masqueraders: Conditions like tropical eosinophilia, Loeffler's syndrome, hypereosinophilic syndrome, and allergic angiitis can mimic asthma symptoms [4].

Asthma Therapy

While considering differential diagnoses, it's essential to remember that asthma therapy should include a high-dose inhaled corticosteroid plus a long-acting beta agonist (LABA) and rescue therapy, as recommended by guidelines [6].

References:

[1] Chronic Sinusitis. Sinusitis is essential to the differential of asthma. [2] Aug 26, 2024 — Diagnostic Considerations · Vocal cord dysfunction or inducible laryngeal obstruction (ILO) · Tracheal and bronchial lesions · Foreign bodies. [3] by N Ullmann · 2018 · Cited by 78 — The diagnosis of asthma should be reconsidered in case of the following: (1) presence of clubbing, cyanosis, significant anemia or nasal polyps; ... [4] by A Gherasim · 2018 · Cited by 34 — Uncommon asthma masqueraders include tropical eosinophilia, Loeffler's syndrome, hypereosinophilic syndrome and allergic angiitis. A detailed ... [5] Nov 18, 2024 — Differential Diagnoses · Anaphylaxis · Aspergillosis · Aspiration Syndromes · Bronchiectasis · Bronchiolitis · Bronchitis · Chronic Obstructive ... [6] by K Narasimhan · 2021 · Cited by 19 — Asthma therapy should include a high-dose inhaled corticosteroid plus a long-acting beta agonist (LABA) and rescue therapy. Nonbiologic add-on ... [7] by N Ullmann · 2018 · Cited by 78 — Lower and upper recurrent respiratory symptoms with no obvious other cause, such as prematurity should suggest to rule out this diagnosis (30). [8] by A Gherasim · 2018 · Cited by 34 — The most common physical finding is airway inflammation. [9] Nov 18, 2024 — Differential Diagnoses · Allergic or Non-Allergic Rhinitis · Gastro-Oesophageal Reflux Disease (GERD) · Post-Nasal Drip.