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Management of difficult asthma

  • Difficult asthma is defined as persistent symptoms and/or frequent exacerbations despite treatment at step 4 or 5

Assessing difficult asthma

  • Patients with difficult asthma should be systematically evaluated, including:
    • confirmation of the diagnosis of asthma, and
    • identification of the mechanism of persisting symptoms and assessment of adherence to therapy
  • This assessment should be facilitated through a dedicated multidisciplinary difficult asthma
    service, by a team experienced in the assessment and management of difficult asthma

Factors contributing to difficult asthma

Poor adherence

  • Healthcare professionals should always consider poor adherence to maintenance therapy before escalating treatment in patients with difficult asthma

Psychological factors

  • Healthcare professionals should be aware that difficult asthma is commonly associated with coexistent psychological morbidity
  • Assessment of coexistent psychological morbidity should be performed as part of a difficult asthma assessment. In children this may include a psychosocial assessment of the family

Monitoring airway response

  • In patients with difficult asthma, consider monitoring induced sputum eosinophil counts to guide steroid treatment

full guidelines available from…

British Thoracic Society, Scottish Intercollegiate Guidelines Network. British guideline on the management of asthma. Thorax 2014; 69: i1–i192. October 2014.
Reproduced with kind permission from BMJ and Thorax.
First included: September 2014.