Can You Answer These 6 Questions About Severe, Uncontrolled Asthma?

Most people know someone—maybe a friend or family member—who lives with asthma, a chronic disease marked by inflammation of the airway that makes it hard to breathe. At the heart of it all, asthma is not the same for everyone. It can have different triggers, attack in different forms, and may sometimes require specialized treatment.

May is Asthma and Allergy Awareness Month, a peak season for the millions of Americans living with asthma and allergies. Here are the six most important questions you need to know about severe, uncontrolled asthma.

1. What is severe, uncontrolled asthma?

   Asthma is an inflammatory disease that causes the airways in the lungs to become swollen or inflamed and over-reactive to triggers like pollen, dust, or smoke. An asthma attack can make it hard to breathe, and in many cases, people don’t recognize their asthma as severe.

   Severe asthma requires medium- to high-dose inhaled corticosteroids plus another asthma controller medication and may require the addition of oral corticosteroids. However, despite using high-dose medicines, reducing risks, and following a treatment plan, many times asthma remains uncontrolled¹.

   According to the American Lung Association, people with uncontrolled asthma experience at least three of the following²:

   • Daytime symptoms like shortness of breath, chest tightness and cough more than twice a week
   • Waking up with nighttime asthma symptoms more than twice a month
   • Using a rescue medicine, such as an inhaler, more than twice a week
   • The need to limit exercise or other daily activities because of asthma symptoms

2. How many people live with severe, uncontrolled asthma?

   Around 5%–10% of asthma cases are diagnosed as severe. About 20%–50% of those are considered to have severe, uncontrolled asthma, which means they are unable to effectively control their condition with currently available medications. It’s estimated that about 1 million people in the U.S. and about 2.5 million people globally live with severe, uncontrolled asthma^3,4.

   "Asthma is among the most common chronic diseases in the world,” says Darryl Sleep, M.D., senior vice president, Global Medical, and chief medical officer at Amgen. “And those living with severe, uncontrolled asthma continue to face significant unmet needs.”

3. Why are asthma cases rising?

   The total number of asthma cases is on the rise—the American Thoracic Society estimates the number of Americans with asthma will grow 10% by 2039. That means asthma is also a serious public health issue, and one study projects that uncontrolled asthma could cost the U.S. health system around $300 billion in that timeframe⁵.

   Scientists don’t know for sure why asthma rates are increasing, but it’s thought that increased urbanization, lifestyle changes, and even growing rates of obesity could play a role.

4. What is it like to live with severe, uncontrolled asthma?

   Life with severe, uncontrolled asthma can be a frustrating, and sometimes frightening, experience. Individuals often refer to asthma attacks as “an elephant sitting on your chest,” or like “breathing through a straw.” And it’s not just asthma attacks themselves that pose challenges. Many people who live with severe, uncontrolled asthma require daily management, and significant changes in their lives to avoid potential triggers.

   Jade Gaelyn-Levai, senior associate, Accounting at Amgen, has severe asthma that can be triggered by anything from mold and pollution to hot weather or fragrances from perfume or shampoo. “I was diagnosed with severe asthma as a toddler,” she says. “It’s very challenging having to avoid a lot of the people, places and things in my life. I’ve had to educate my family, friends, and colleagues on my triggers, so they are aware of how they affect me.”

5. Are there racial disparities among asthma patients?

   Asthma, including severe, uncontrolled asthma, disproportionately affects Black, Hispanic and Indigenous Americans. Black Americans not only have higher rates of asthma, but also significantly worse outcomes, being five times more likely to seek emergency care for asthma than white Americans, according to the Asthma and Allergy Foundation of America⁶.

6. How many people with severe asthma have seen a specialist?

   In the U.S., only 38% of patients with severe asthma have seen a specialist—such as a pulmonologist, allergist or immunologist—over the past two years. That means more than 60% of Americans living with severe asthma are not getting specialized care that could help them find the right combination of medications and lifestyle changes to better manage their condition⁶.

   “Many people living with severe asthma either don’t get the level of care they need or have access to medicines to effectively control their conditions,” says David M. Reese, M.D., executive vice president of Research and Development at Amgen. “It’s vitally important that we encourage patients to seek out specialized care, while also advancing the science in the understanding of severe, uncontrolled asthma.”

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1. https://www.aaaai.org/conditions-and-treatments/library/asthma-library/severe-asthma
2. https://www.lung.org/lung-health-diseases/lung-disease-lookup/asthma/learn-about-asthma/severe-asthma
3. Kupczyk M, Wenzel S. U.S. and European severe asthma cohorts: what can they teach us about severe asthma? J Intern Med 2012;272:121–32.
4. Wenzel S. Severe Asthma in Adults. Am J Respir Crit Care Med. 2005; 172; 149–60.
5. “Uncontrolled Asthma Over Next 20 Years Likely to Add $300 Billion to U.S. Health Care Bill,” July 1, 2019. American Thoracic Society. https://www.thoracic.org/about/newsroom/press-releases/journal/2019/uncontrolled-asthma-over-next-20-years-likely-to-add-300-billion-to-us-health-care-bill.php
6. Asthma and Allergy Foundation of America. Asthma Facts. 2021. Retrieved from: https://www.aafa.org/asthma-facts/