Treating Severe Asthma

People with severe asthma will use many of the same preventer and reliever medicines used by people with mild to moderate asthma. However, people with severe asthma do not respond as well to these commonly prescribed asthma treatments, and often require additional treatment options.

Severe asthma is not the same for everyone. So finding the right treatment options may take time and will differ from person to person.

The goal of asthma treatment is to achieve the best possible level of asthma control with the lowest amount of treatment.People with severe asthma tend to have more symptoms or flare-ups even when taking the highest recommended level of preventer treatment. They may need the highest recommended level of preventer treatment continuously to control their asthma. At this point a referral to a specialist is recommended.

It’s important your healthcare professional checks your inhaler technique and makes sure you are taking your medicine properly and getting the full dose into your lungs every day. Sometimes just a simple tweak to your technique can improve how much medicine makes it to your lungs. This can improve your asthma control. You can check your technique for a range of inhalers by watching the videos here.

People with severe asthma will mostly likely need to take some of the following medications:


Preventers contain an inhaled corticosteroid, ananti-inflammatory, to reduce the inflammation, sensitivity and excess mucus in the airways.  This will reduce your symptoms and flare-ups and reduce the likelihood of reacting to triggers. Your preventer should be taken every day as prescribed.

If you have been diagnosed with severe asthma, you will probably already be on the highest recommended dose of your preventer inhaler.

Combination Preventer

Combination preventers contain two medicines within the one inhaler.

The first medicine is an inhaled corticosteroid to reduce the inflammation, sensitivity and excess mucus in the airways. This acts  to reduce your symptoms and flare-ups and reduce the likelihood of reacting to triggers.

The second medicine is  a long-acting bronchodilator to relax tightened airway muscles. Your inhaled combination preventer should be taken every day as prescribed.

If you have been diagnosed with severe asthma, you will probably already be on the highest dose of your combination preventer inhaler.


Everyone with asthma should have a reliever medication. Relievers are fast-acting medications that give quick relief of asthma symptoms. They open the airways quickly by relaxing the airway muscles. Using your reliever more than two days per week is a sign of uncontrolled asthma.

There is some evidence that people who overuse reliever medications may develop a form of tolerance to the medicine. This means your body starts to get used to the medicine and you need higher doses for it to work or it may not work as well in the case of an emergency.

Blue or grey reliever inhalers, such as, Asmol, Ventolin and Bricanyl, contain only a bronchodilator medication to relax the airway muscles for four to six hours. This does not prevent symptoms from occurring again.

Add-on medication

If you have severe asthma, sometimes other types of medication are used together with a preventer and a reliever to help control the symptoms of asthma. These add-on medications are used to improve your lung function and reduce asthma flare-ups. They should be used with a preventer medication. If you experience asthma symptoms or flare-ups, you will still need to use your reliever inhaler.

Add-on medications for severe asthma include:

Spiriva Respimat

This medicine may be an option for people over 18 years who have severe asthma despite regular use of high-dose combination preventer medication.

This treatment works to relax the muscles around the outside of the airway and keep them relaxed for up to 24 hours. It is a once-daily, inhaled medicine and should only be used in addition to a preventer medicine. It does not replace preventer medication. When used as an add-on treatment to preventer medications it can improve lung function and reduce asthma flare-ups.

Spiriva Respimat does not replace your blue or grey reliever. You should carry your blue or grey reliever medicine at all times in case of asthma symptoms.

For video demonstrations of how to use Spiriva Respimat click here. You can read the Consumer Medicine Information sheet.

Oral Corticosteroids

People with asthma are sometimes prescribed short courses of oral corticosteroid tablets, such as prednisolone, to help get their asthma under control during a flare-up.

This is a powerful anti-inflammatory medicine which helps by quickly reducing the inflammation in your lungs. It is much stronger than the inhaled corticosteroid that  is in your preventer inhaler.

For a small number of people with severe asthma who continue to  experience asthma symptoms and frequent flare-ups, your doctor or specialist may prescribe steroid tablets for longer periods. This could be months or years. Your doctor or specialist will only prescribe this if it is necessary to prevent you from having regular flare-ups.

You are more likely to have some side effects if you’re on long-term oral corticosteroid tablets, compared to people who only take a short course when their symptoms get worse. If you take steroids in tablet form for three months or more continually, or if you have three to four courses a year, you’ll be at higher risk of side-effects.

The potential side effects from oral steroids include:

  • Weight gain
  • Reflux and bloating
  • Mood swings
  • Poor sleep
  • Bone fractures (osteoporosis)
  • Susceptibility to infection
  • Risk of diabetes
  • Cataracts

The goal is always to make sure you’re on the lowest dose of medicines needed to manage your asthma and reduce your risk of a potentially life-threatening asthma flare-up.

Your doctor will be aware of the possible side effects of steroid tablets and will monitor the doses and medicines you need for your asthma. To reduce the risk of side effects, your doctor will keep you on the lowest possible dose of steroid tablets. In order to do this, your doctor will keep prescribing your preventer inhaler at the maximum dose. However, you should never stop taking your steroid tablets without speaking with your doctor.

What you can do to minimise side effects:

  • Take your steroid at the right time of the day for you and with food where possible
  • Make sure you are taking your preventer medication every day as prescribed
  • Make sure you are using your inhalers correctly
  • Quit smoking as it can increase the risk of asthma flare-ups and fracture
  • Check with your doctor that you have sufficient vitamin D levels and ask about how you can maintain your bone health
  • Make sure you have regular health checks with your doctor
  • Eat a healthy balanced diet and get appropriate exercise (discuss the level and type of exercise suitable for you with your doctor)

Speak to your doctor about your concerns and discuss your options.


For some people with severe asthma there are add-on medicines that can be used to reduce the need for steroid tablets. These are called biologics, sometimes called steroid-sparing treatments or monoclonal antibodies.

Click here to read more about severe asthma, treatments and medicines.