How is difficult asthma managed?

¹ Respiratory Health Services Research Group, Charing Cross Hospital
² Leukocyte Biology Section and Dept of Allergy and Clinical Immunology, NHLI Division, Imperial College London

^* To whom correspondence should be addressed. E-mail: m.partridge{at}imperial.ac.uk.

	Abstract

Most patients with asthma can be easily treated. Some have difficult asthma; in some because the diagnosis is erroneous, in others because of co-morbidity or non-compliance. An ERS taskforce has called for an integrated approach for these patients; positive results have been reported using protocols. In the UK there is no overall understanding of the size of this problem, or how these patients are managed.

Postal survey of 683 consultant members of the British Thoracic Society designed to elicit respondents' views on how they would manage four clinical scenarios.

There was a 50.4% response rate. Few reported a uniform approach to the investigation of such patients. The availability of allied healthcare professionals was variable. The 21 consultant respiratory physicans specialists reporting a special interest in difficult asthma were significantly more likely to objectively assess compliance, perform skin-prick tests, and to utilise a liaison psychiatrist, than those without expressed special interest in asthma. Many reported difficulty in accessing psychologists, liaison psychiatrists and social workers. Approaches to the diagnosis and management of "vocal cord dysfunction" were variable.

The results of this postal survey of specialist thoracic physicians in the UK suggests that a protocol for difficult asthma is not in widespread use and that access to necessary allied healthcare professionals is not uniform. Pulmonologists with a declared special interest in difficult asthma may have configured their services and approaches more in line with that proposed by the ERS task force.

This article has been cited by other articles:

				G. P Currie, J G. Douglas, and L. G Heaney Difficult to treat asthma in adults BMJ, February 24, 2009; 338(feb24_1): b494 - b494. [Full Text]

				M. R. Partridge Examining the unmet need in adults with severe asthma Eur. Respir. Rev., September 1, 2007; 16(104): 67 - 72. [Abstract] [Full Text] [PDF]

				P. Chanez and P. Godard Is difficult asthma still clinically meaningful? Eur. Respir. J., November 1, 2006; 28(5): 897 - 899. [Full Text] [PDF]