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Copyright ©ERS Journals Ltd 2003
Systematic assessment of difficult-to-treat asthma
1 Depts of Allergy, 3 Upper Respiratory Medicine, 4 Thoracic Medicine, National Heart and Lung Institute, Faculty of Medicine, Imperial College and 2 Royal Brompton and Harefield NHS Trust, London, UK
CORRESPONDENCE: D.S. Robinson, Dept of Allergy and Clinical Immunology, National Heart and Lung Institute, Faculty of Medicine, Imperial College London, Dovehouse Street, London, SW3 6LY, UK. Fax: 44 2073518135. E-mail: d.s.robinson@imperial.ac.uk
Keywords: adherence, diagnosis, psychiatry, severe asthma
Received: February 14, 2003
Accepted May 23, 2003
D.A. Campbell is funded by the Joint Research Committee of the Royal Brompton and Harefield Trust and National Heart and Lung Institute. D.S. Robinson was funded in part by the Wellcome Trust.
Five per cent of asthmatics remain symptomatic despite high-dose treatment. The aim of the study was to investigate how often such difficult-to-treat asthma is due to intractable asthma, misdiagnosis, non-adherence with therapy, or psychiatric problems.
Difficult asthma was defined as persistence of symptoms despite treatment at step 4 of British guidelines or requirement for long-term oral glucocorticoids (step 5). One-hundred patients with a respiratory physician diagnosis of asthma were investigated in a single tertiary respiratory unit in an open and descriptive study.
Twelve of the patients studied did not have asthma and a further seven had additional diagnoses. Of the remainder, 55 had an asthma diagnosis confirmed by demonstration of reversible airflow narrowing or peak flow variability, whilst 20 did not. Noncompliance with prednisolone therapy was more frequent in the 55 with confirmed asthma (nine of 18 prescribed oral prednisolone at a dose of
Systematic evaluation of difficult asthma is useful as it can identify alternative or additional diagnoses, psychiatric illness or nonconcordance with therapy in a substantial proportion of cases (32% in the present series).
15 mg·day–1) and was not detected in the "unconfirmed asthma" group. There were no other significant differences between these groups. A major psychiatric component was detected in 10 patients.
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