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Severe Asthma

Severe Asthma - What it is

Millions navigate life with asthma symptoms daily, considering them part of the norm. The reality is, asthma persists, posing the risk of enduring, irreversible lung damage. Despite years of coping, if symptoms impede desired activities and persist, it's time for a thorough reevaluation of your understanding of asthma.

Approximately 5-10% of asthma patients grapple with Severe Asthma, enduring persistent symptoms or frequent flare-ups despite adhering to high doses of inhaled preventer medications and occasionally oral steroids.

Recent advancements in asthma science underscore the existence of various asthma types. Identifying your specific type is crucial, as deep lung inflammation, known as Type 2 inflammation, can manifest as "eosinophilic" or "allergic" asthma.

Severe Asthma - Symptoms

​Some signs of poor asthma control include: 

  • Frequent symptoms such as shortness of breath, wheezing, coughing, waking up at night with difficulty breathing, and/or limitation of daytime activities
  • Use of fast-acting reliever medications such as Salbutamol inhaler or additional doses of Budesonide-Formotero several times a week
  • Recurrent hospital admissions, emergency room Visits, and/or visits to a doctor requiring oral steroids for flare-ups 
  • Impaired lung function

Severe Asthma - How to prevent?

Severe Asthma - Causes and Risk Factors

Severe Asthma - Diagnosis

Severe Asthma - Treatments

​Treating severe asthma involves the use of biologics.

Biologics are relatively new medications that are not made from chemicals but are made from the cells of a living
organism, such as bacteria or mice.

Patients experiencing uncontrolled severe asthma, despite optimal daily preventer medications, may find biologics beneficial.

Preconditions Before Starting Biologics

Work with your healthcare provider to ensure that you: 
  • You are taking your preventer medications as intended, and are using your inhaler devices correctly
  • You are avoiding triggers for your asthma, wherever possible
  • You do not have other medical condltions that are contributing to your poor asthma control

Benefits of Biologics

  • Reduce frequency of asthma attacks and symptoms
  • Reduce healthcare visits i.e hospital admission emergency room visits that require oral steroids
  • For patients on regular oral steroids, the dose required to control asthma may be reduced
  • Reduce the need for other add-on medications [and hence reduce side effects]
  • Fewer missed work/school days
  • Improve quality of life
  • Some blologics may even mprove lung function and other conditions which are caused by abnormal nflammatlon, similar to the asthma that is affecting you

Types of Biologics

In 2021, Health Sciences Authority in Singapore approved four biologics with more in development and clinical trials.
  1. Omalizumab
  2. Mepolizumab
  3. Benralizumab
  4. Dupilumab, 

Choosing a Biologic

Different biologics target different inflammatary and allergic pathways in asthma. Your doctor conducts screening tests to determine the most suitable biologic targeting specific inflammatory and allergic pathways.


How are Biologics Administered?

Given through subcutaneous injections, biologics may be administered bi-weekly, monthly, or bi-monthly, depending on the specific biologic.

Monitoring for improvement may take up to six months, and treatment duration depends on the sustained response.

Side Effects of Biologic

While generally safe, common side effects include soreness at the injection site, headache, sore throat, and fatigue. Rarely, more severe side effects such as swelling of the eyes, hives, rashes, fainting or dizziness, and difficulty breathing may occur.

Severe Asthma - Preparing for surgery

Severe Asthma - Post-surgery care

Severe Asthma - Other Information

​Cost of Biologic

Biologics may have a high annual cost (up to thousands per year), but for some, the expense may outweigh the cost of managing symptoms and flare-ups.

How You Can Manage Severe Asthma

Aside from seeking medical treatment, the following are some ways you can manage your health:

  • Taking regular preventer medications: Do not stop the medications on your own, even when you
    feel better wIth the blologic
  • Exercise: Research has shown that physical activity for people with severe asthma helps improve their quality of life
  • Eating well: A healthy diet and staying active is good for the heart and lungs even if you have severe asthma
  • Do not smoke: Find it tough to quit smoking? Let us know and we will refer you to a smoking cessation counsellor
  • Vaccination: Individuals with severe asthma are more likely to get complications from flu. This can be reduced by an annual influenza vaccination
Proactive management is the key to improving your quality of life. Collaborate with our doctors at the Severe Asthma Clinic to create an asthma management plan, monitor symptoms, and adhere to prescribed medications. Open communication with your doctor positively influences asthma management and enhances daily well-being.

Download a copy of our leaflet in your preferred language to learn more:
The information provided is not intended as medical advice. Terms of use. Information provided by SingHealth

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