Asthma is a disease in which the airways swell up and tighten, making it hard to catch your breath. Symptoms include:

  • wheezing
  • shortness of breath
  • chest tightness

Symptoms can be more severe in some people and less so in others. You might only have symptoms at certain times — like when you exercise. Or you could have frequent asthma attacks that affect your quality of life.

Asthma isn’t curable, but it is controllable. Today’s treatments are more effective than ever before at preventing asthma attacks — and at stopping symptoms if they do start. Yet of people with asthma don’t respond to standard treatments like inhaled corticosteroids.

For those with severe and stubborn symptoms, a new generation of therapies — and certain treatments on the horizon — might finally offer some relief.

Purpose of asthma treatments

Asthma treatment involves a three-part strategy:

  • provide long-term control medications to prevent symptoms before they start
  • quick-relief medications to stop asthma attacks
  • avoiding triggers to reduce the number of attacks

To control severe asthma, you may need to take higher doses of medications or use more than one drug. You and your doctor can create an asthma action plan to personalize your treatment strategy based on your symptoms and disease severity.

Treatment options

The main treatment for severe asthma is long-term control medications that help prevent asthma symptoms. These include:

  • inhaled corticosteroids
  • inhaled long-acting beta-agonists
  • inhaled long-acting anticholinergics
  • leukotriene modifiers
  • cromolyn sodium (Intal)
  • theophylline (Theochron)
  • oral corticosteroids

Then you can take quick-relief medications when you have an asthma attack to relieve symptoms. These include:

  • inhaled short-acting beta-agonists
  • inhaled short-acting anticholinergics
  • a combination of an inhaled short-acting anticholinergic and inhaled short-acting beta-agonist

A few newer treatments have made severe asthma easier to control.

Biologics

Biologic drugs work with your immune system to treat asthma. They block the activity of immune system chemicals that make your airways swell up. These drugs can prevent you from getting asthma attacks and make the attacks you do have much milder.

Four monoclonal antibodies are currently approved to treat severe asthma:

  • reslizumab (Cinqair)
  • mepolizumab (Nucala)
  • omalizumab (Xolair)
  • benralizumab (Fasenra)

Omalizumab treats severe asthma that’s triggered by allergies. Mepolizumab, reslizumab, and benralizumab treat severe asthma that’s caused by a type of white blood cell called an eosinophil (eosinophilic asthma). You take these drugs by injection or through an IV into a vein. New monoclonal antibodies such as tezepelumab are under investigation.

Tiotropium (Spiriva)

This inhaled medication has been used to treat chronic obstructive pulmonary disease (COPD) for more than a decade. In 2015, the FDA also approved it for the treatment of asthma. show that tiotropium improves asthma control when added to high doses of inhaled corticosteroids plus short-acting beta-agonists.

Leukotriene modifiers

One group of asthma drugs works by blocking the action of leukotriene. This chemical tightens and narrows your airways during an allergy-induced asthma attack.

Three leukotriene modifiers are approved to treat asthma:

  • montelukast (Singulair)
  • zafirlukast (Accolate)
  • zileuton (Zyflo)

You take these medications by mouth to prevent or treat asthma attacks.

Bronchial thermoplasty

Bronchial thermoplasty is a surgical technique used for severe asthma that hasn’t improved with other treatments. During this technique, radiofrequency energy is applied to the airway. The heat that’s generated destroys some of the smooth muscle lining the airway. This prevents the muscle from constricting and narrowing the opening.

Bronchial thermoplasty is delivered in three sessions, each given three weeks apart. Although it isn’t a cure for asthma, shows it does reduce symptoms.

The future of severe asthma treatments

Researchers are still searching for new drugs that will be able to prevent and relieve asthma symptoms. One drug that has generated a lot of excitement is Fevipiprant (QAW039). Though still in development, this experimental drug reduced symptoms and in people with allergic asthma that inhaled corticosteroids couldn’t control. If Fevipiprant is approved, it would be the first new oral asthma drug to be introduced in 20 years.

Other studies are investigating the factors that play a role in asthma development. Identifying the triggers that set off asthma symptoms could one day enable researchers to stop those processes and prevent asthma before it starts.