difficult asthma

Last reviewed 03/2019

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

  • MONITORING AIRWAY RESPONSE- In patients with difficult asthma, consider monitoring induced sputum eosinophil counts to guide steroid treatment.