Uncontrolled asthma refers to asthma that causes frequent symptoms, or flare-ups. This may occur because the asthma is untreated or because current treatments are not working well enough.

Doctors can treat uncontrolled asthma by prescribing medications or adjusting the medications a person currently uses so they are more effective.

However, there are barriers that prevent people from getting the treatment they need. In 2019, about 60% of adults with asthma in the United States had uncontrolled asthma. Factors such as health insurance, geographical location, and the cost of medications can all play a role in this.

In this article, we will discuss uncontrolled asthma, including its symptoms, causes, and treatment.

A man in a bedroom using an inhaler for uncontrolled asthma.Share on Pinterest
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Asthma causes inflammation and narrowing of the airways in the lungs, which interferes with breathing. Uncontrolled asthma refers to cases where asthma symptoms are frequent or occur daily.

A person with uncontrolled asthma may experience:

  • frequent flare-ups
  • more frequent asthma attacks, hospitalizations, or emergency department visits
  • a need for reliever inhalers or medications a few times a week or every day
  • difficulty with daily activities, such as working or exercising

People with controlled asthma do not experience this. Although people with controlled asthma have symptoms sometimes, they are still able to carry out their usual activities.

The symptoms of uncontrolled asthma include frequent:

People experiencing symptoms of uncontrolled asthma should try to speak with a doctor as soon as possible. A doctor can help recommend the best treatments and ways of reducing asthma symptoms.

A person should dial 911 or the number of the nearest emergency department immediately if they or someone they know:

  • cannot breathe
  • becomes drowsy or confused or loses consciousness
  • develops blue, gray, or white lips or nails
  • does not experience relief from (or does not have access to) things that usually help, such as quick-relief medications
  • has peak flow meter readings that are less than half of their best peak flow

Peak flow meters are devices people can use to monitor their asthma symptoms.

Uncontrolled asthma can develop for several reasons. A person may:

  • not receive any treatment
  • receive treatments but have trouble understanding when or how to use them
  • receive treatments that do not work sufficiently to control symptoms
  • avoid using treatments due to unpleasant side effects

Difficulty accessing healthcare or affording prescriptions can be a significant barrier to controlling asthma symptoms. Similarly, people from marginalized communities may be less likely to visit a doctor for healthcare due to distrust and discrimination.

Living in more rural locations may also affect a person’s ability to get treatment. In the U.S., the highest incidence of uncontrolled asthma occurs in states such as Utah and Missouri, where the rate is 72.4%.

Asthma symptoms may also become more frequent if a person smokes or has other chronic health conditions. Conditions that may worsen asthma include:

Anyone can have uncontrolled asthma if their symptoms are frequent. This includes people with mild or moderate symptoms.

In contrast, severe asthma means a person experiences severe symptoms that do not respond to typical treatments, such as high dose steroid inhalers combined with another medication.

If treatment does not help control a person’s uncontrolled asthma, a doctor may test them for signs of severe asthma.

Uncontrolled asthma can result in more frequent asthma attacks, which can disrupt daily life. Without prompt treatment, they can also be life threatening.

Other potential complications of uncontrolled asthma include:

Treatment for uncontrolled asthma typically involves starting new medications or adjusting existing ones.

First, a doctor may assess a person’s lung function. They may ask questions about any known triggers or how well the current medications are working, if relevant.

They may ask to watch a person use their inhaler to verify that they are using it correctly. If they are not, the doctor may help them learn how to use it and see if that helps with the symptoms.

If a person is using their inhaler correctly, the doctor may look into adding to or adjusting a person’s treatment plan. This may involve trying:

The addition of LABAs may improve lung function and increase the number of symptom-free days, while the addition of LTRAs may help prevent asthma attacks.

Biologics are another treatment option for uncontrolled asthma. They can help block the triggers that lead to airway inflammation.

The Food and Drug Administration (FDA) has approved six biologics for the treatment of uncontrolled asthma. These are:

Doctors can administer biologics via an IV or as an under-the-skin injection. A person should consult with their doctor to understand which treatment option is most suitable for them.

Uncontrolled asthma is when a person has frequent or daily asthma symptoms that interfere with their life. They may have difficulty working, exercising, or sleeping. They may also experience more frequent asthma attacks and have to visit the emergency department more often.

There are several reasons why asthma can become uncontrolled, from difficulty accessing healthcare to using inhalers incorrectly. Wherever possible, it is important to speak with a doctor about the symptoms so that there is a lower risk of complications or severe attacks.