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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…
thorax.bmj.com/content/69/Suppl_1.toc

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.