n CME : Your SA Journal of CPD - Difficult asthma : main article

Volume 26, Issue 4
  • ISSN : 0256-2170



  • Some asthmatics will have persistent symptoms despite apparently adequate treatment.
  • Review possible factors, such as treatment adherence, that lead to poor control before labelling a patient as having resistant asthma.
  • Poor adherence to treatment and poor inhaler technique are probably the most common reasons why suboptimal control is achieved.
  • Chronic sinusitis and upper airways allergy as well as gastro-oesophageal reflux are also associated with poor asthma control.
  • Always refer to a specialist when a patient has resistant asthma in order to rule out alternative diagnoses.
  • Some patients have persistently low lung function and significant baseline breathlessness which deteriorates at times of exacerbations.
  • Other patients may have well-preserved lung function but unstable airways and can deteriorate acutely and severely. They are called brittle asthmatics.
  • All patients with difficult asthma require high-dose inhaled corticosteroids and many severe asthmatics will need oral steroids periodically.

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