Difficult asthma

Difficult Asthma

• Difficult asthma is defined as persistent symptoms and/or frequent asthma attacks despite treatment with high-dose therapies

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
  
• PSYCHOSOCIAL 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
  
• DYSFUNCTIONAL BREATHING - Dysfunctional breathing should be considered as part of the assessment of patients with difficult asthma
  
• ALLERGY - In patients with difficult asthma and recurrent hospital admission, allergen testing to moulds show be performed.
  
• MONITORING AIRWAY RESPONSE- In patients with difficult asthma, consider monitoring induced sputum eosinophil counts to guide steroid treatment.

Reference:

• (1) British Thoracic Society (BTS)/Scottish Intercollegiate Guidelines Network (SIGN) 2019. British Guideline on the Management of Asthma. A national clinical guideline.