How do doctors know when to step up treatment for severe asthma?

Leading board-certified allergists and pulmonologists recently developed a series of recommendations called the Asthma Yardstick. Published in February 2017 in Annals of Allergy, Asthma and Immunology, it offers guidance for doctors on treating patients with severe asthma.

The Asthma Yardstick uses patient profiles to help allergists determine what steps can be taken in treatment.

Here are two examples:

Patient Profile 1
Patients with moderate-to-severe asthma who have had symptoms for at least two months or require oral corticosteroids to treat a flare twice in the past year despite being on low-dose inhaled corticosteroids may be candidates for medium-dose inhaled corticosteroids, combination asthma medications or leukotriene inhibitors.

Patient Profile 2
Patients with uncontrolled asthma who show persistent eosinophil-related (blood cells) inflammation despite taking high-dose inhaled corticosteroids and long-acting beta2-agonists may be candidates for biologics that target eosinophils.

Doctors must also take into account: Is the patient following the medication schedule and using the prescribed inhaler correctly? Are there other medical conditions worsening symptoms? Is cost of medications a factor?

“Dialogue is critical to ensure that patients, families and healthcare professionals agree on what is meant by good asthma control and how best to achieve it,” says Bradley Chipps, MD, co-author of the Asthma Yardstick and board-certified allergist and pediatric pulmonologist with Capital Allergy and Respiratory Disease Center in Sacramento, California.

The full text of the Asthma Yardstick recommendations can be found at the Annals website.

For information on severe asthma diagnosis, management and treatment, a Severity Assessment Tool, an Asthma Control Quiz, and asthma resources and fact sheets, visit, a website co-sponsored by Allergy & Asthma Network and the CHEST Foundation.

Bronchial Thermoplasty:
A Procedure for Severe Asthma

Even with a step-up of medications, certain severe asthma patients will continue to experience symptoms.

For these patients, doctors may recommend bronchial thermoplasty, an outpatient procedure. It involves inserting a long, slender tube called a bronchoscope into the lungs and airways to heat and reduce muscle tissue.

The procedure decreases the ability of the airways to constrict, allowing more air to pass. It’s performed in three outpatient visits scheduled 3-4 weeks apart, with each procedure targeting a different section of the lungs.

If you have severe, difficult-to-control asthma, talk with your doctor to determine if bronchial thermoplasty is right for you. Be sure to check your health insurance to confirm if it’s covered.