Many patients labelled as having severe asthma turn out to have difficult-to-treat asthma: poor adherence, poor inhaler technique, ongoing exposures, or untreated comorbidities such as rhinosinusitis, reflux, obesity, dysfunctional breathing or inducible laryngeal obstruction.
Severe asthma is diagnosed only when control is not achieved despite high-dose treatment taken correctly, or is lost when treatment is reduced. Check prescription refill records, watch the patient use the inhaler, and ask about smoke, biomass fuel and workplace exposures before escalating.
- Watch the patient use their inhaler at every review
- Check refill records to confirm the controller is actually being collected
- Ask about smoking, biomass smoke and occupational exposures
- Screen for rhinosinusitis, reflux, obesity and dysfunctional breathing
Why it matters
Most uncontrolled asthma improves with fixes that cost far less than a biologic.
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