Published 24 February 2009, doi:10.1136/bmj.b494
Cite this as: BMJ 2009;338:b494

Clinical Review

Difficult to treat asthma in adults

Graeme P Currie, consultant chest physician1, J Graham Douglas, consultant chest physician1, Liam G Heaney, consultant chest physician2

1 Aberdeen Royal Infirmary, Aberdeen AB25 2ZN, 2 Belfast City Hospital, Belfast BT9 7AB

Correspondence to: G P Currie Graeme.currie@nhs.net

The first 150 words of the full text of this article appear below.


Difficult asthma is present when patients using treatment at steps 4 or 5 of the British Thoracic Society and Scottish Intercollegiate Guideline Network guidelines remain symptomatic and have exacerbations
Determine whether the patient truly has asthma, whether prescribed treatment is being taken, and whether an alternative or coexisting diagnosis or aggravating factors exist
After taking a detailed history and examination, further directed investigations may be needed
Assessment and further management should ideally take place within a multidisciplinary clinic setting


There is no universally accepted definition of difficult asthma. However, it is reasonable to consider it present when people have persistent symptoms and frequent exacerbations, despite being treated at steps 4 or 5 of the British Thoracic Society and Scottish Intercollegiate Guideline Network (BTS/SIGN) guidelines (fig 1Go).1 Such patients typically receive high dose inhaled steroids (≥800 µg beclometasone equivalent), a long acting β2 agonist, plus add-on treatment. The prevalence . . . [Full text of this article]

History
Examination
Blood tests
Pulmonary function
Radiography
Other tests (as clinically indicated)

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