Many patients labelled as having difficult asthma improve once inhaler technique, adherence and comorbidities are addressed. Severe asthma is defined as asthma that remains uncontrolled despite high-dose inhaled corticosteroid plus a second controller, or that needs this to stay controlled — after those basics have been checked.
Watching the patient use their own device, reviewing prescription refill records, and looking for rhinosinusitis, reflux, obesity, smoking and dysfunctional breathing are the first steps before biomarker testing or biologic referral.
- Watch the patient use their own inhaler at every review.
- Check refill records; collection rates often reveal poor adherence.
- Look for rhinosinusitis, reflux, obesity, smoking and dysfunctional breathing.
- Measure blood eosinophils and FeNO once basics are addressed, before biologic referral.
Why it matters
Escalating treatment for poorly used inhalers adds cost and side effects without control.
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