Frequent wheezing, breathlessness, night waking or repeated need for quick-relief medication may indicate that asthma is not adequately controlled. However, persistent symptoms do not automatically mean that someone has severe asthma or needs increasingly strong treatment. The 2026 Global Initiative for Asthma guidance stresses structured assessment of diagnosis, treatment, risk factors and other contributors before difficult-to-treat asthma is classified as severe.
1. Is the diagnosis correct?
Asthma causes variable narrowing and inflammation of the airways.
Typical symptoms can include:
- Wheezing
- Chest tightness
- Cough
- Breathlessness
- Symptoms during exercise
- Night-time or early-morning symptoms
But several other problems can resemble asthma.
These may include vocal-cord disorders, chronic obstructive pulmonary disease, heart conditions, reflux, anxiety-related breathing symptoms or another lung condition.
Where appropriate, lung-function testing can help confirm variable airflow limitation.
Cura Hospitals currently lists pulmonary-function testing as part of its pulmonology services alongside asthma and other respiratory conditions.
2. Is the inhaler being used correctly?
An effective medicine may not work as intended if little of it reaches the lungs.
Common problems include:
- Not coordinating inhalation correctly
- Breathing in too quickly or slowly for the device
- Failing to prepare the inhaler properly
- Poor spacer technique
- Not holding the breath after inhaling when instructed
- Using an empty or expired device
Technique should be demonstrated and then checked in person.
Simply asking a patient whether they know how to use an inhaler may not identify errors.
3. Is treatment being taken consistently?
Some people use their controller medicine only when symptoms are severe.
Others may reduce treatment because they are feeling better, worry about side effects or find the routine difficult.
These barriers should be discussed without judgement.
GINA’s current 2026 resources continue to emphasise evidence-based asthma management and assessment of modifiable factors before escalating treatment.
Patients should not stop prescribed inhaled or oral medicines suddenly without discussing the change with their clinician.
4. Are triggers or other conditions contributing?
Asthma symptoms may worsen with:
- Tobacco smoke
- Air pollution
- Dust or allergens
- Viral infections
- Occupational exposure
- Exercise
- Certain medicines
- Poorly controlled allergic rhinitis
Other health conditions can also make asthma harder to manage.
These may include obesity, reflux, chronic sinus disease and sleep-disordered breathing.
A treatment review should therefore look beyond the lungs alone.
5. Is this actually severe asthma?
Severe asthma is not simply asthma that feels severe during one bad week.
GINA distinguishes severe asthma from difficult-to-treat asthma. Persistent symptoms may first require confirmation of the diagnosis, optimisation of treatment and attention to adherence, technique, triggers and other medical conditions.
Selected patients with truly severe asthma may require specialist testing and additional treatment.
When should asthma be reviewed?
Arrange a clinical review when:
- Symptoms regularly disturb sleep
- Exercise becomes difficult
- Quick-relief medication is needed increasingly often
- There have been repeated emergency visits
- Oral steroid courses are repeatedly required
- Symptoms continue despite prescribed treatment
- It is unclear how to use the inhaler correctly
Cura Hospitals’ pulmonology department currently lists asthma management, COPD care, respiratory infections, sleep-disordered breathing and pulmonary-function testing among its services. Readers with continuing symptoms can review its specialist asthma management information.
When is asthma an emergency?
Seek emergency medical attention for severe breathlessness, difficulty speaking in complete sentences, blue or grey lips, confusion, collapse, or rapidly worsening symptoms that do not respond to the person’s prescribed emergency plan.
A person with a serious asthma attack should not rely on online advice instead of urgent medical care.
This article provides general education and does not replace diagnosis, an asthma action plan or treatment from a qualified clinician.