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