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Guidelines stress importance of accurate diagnosis of difficult-to-control asthma

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Updated asthma guidelines have called for greater recognition of difficult-to-control asthma.

The British Guideline on the Management of Asthma has been produced by the Scottish Intercollegiate Guidelines Network (SIGN) and the British Thoracic Society (BTS). It contains a
new section on difficult asthma that occurs when a patient who has been diagnosed with asthma continues to have symptoms and exacerbations despite using high-dose asthma therapy.

This new section emphasises the importance of accurate diagnosis in this group of patients, where it is often necessary to separate out several co-morbidities.

Greater use of personalised action plans is also recommended to improve health outcomes. The evidence for using these plans is particularly good for those in secondary care with moderate to severe asthma. Asthma UK have produced a ‘Be in Control’ action plan that can be downloaded from

Difficult asthma

Difficult asthma is defined as persistent symptoms and/or frequent exacerbations despite high-dose treatment.
Patients should be systematically evaluated to:

  • Confirm the diagnosis;

  • Identify the mechanisms of persisting symptoms and assessment of adherence with therapy.

Assessment should be carried out by a dedicated multidisciplinary ‘difficult asthma’ service.


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