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Severe Asthma

In people with severe asthma, the normally-tiny muscles in the walls of the airways are larger than in non-asthmatics. The airways close down when these muscles contract. When airways close down, it becomes difficult to breathe making the chest feel tight. Coughing and wheezing are also common. Medicine is typically necessary to relax and reopen the airways though medicine doesn’t always work well for those with severe asthma. Bronchial thermoplasty (BT) is a procedure that may be effective in treating more severe cases.

Signs & Symptoms

Asthma symptoms vary from person to person and can range from infrequent attacks or situational symptoms – like those that occur only when exercising – to serious symptoms all the time.

Common signs and symptoms of asthma include:

  • Shortness of breath
  • Chest tightness or pain
  • Trouble sleeping cause by shortness of breath, coughing or wheezing
  • A whistling or wheezing sound when exhaling
  • Coughing or wheezing attacks that get worse with cold or flu

Signs that your asthma is probably worsening include:

  • Asthma signs and symptoms that are more frequent and bothersome
  • Increasing difficulty breathing (measurable with a peak flow meter, a device used to check how well your lungs are working)
  • The need to use a quick-relief inhaler more often

For some, signs and symptoms flare up in certain situations:

  • Exercise-induced asthma, which may be worse when the air is cold and dry
  • Occupational asthma, triggered by workplace irritants such as chemical fumes, gases or dust
  • Allergy-induced asthma, triggered by airborne substances, such as pollen, mold spores, cockroach waste or particles of skin and dried saliva shed by pets (pet dander)


A Deborah Heart and Lung Center physician will listen to the patient’s lungs using a stethoscope. Wheezing or other asthma-related sounds may be heard. The doctor may also choose to order additional tests, such as:

  • Allergy testing (skin or blood)
  • Arterial blood gas (done during a severe attack)
  • Chest x-ray
  • Lung function tests