A diagnostic approach to 'difficult' asthma

When patients with asthma do not respond adequately to standard treatment, they are said to have "difficult" asthma. These patients require a lot of healthcare resources, are usually receiving long-term oral corticosteroid therapy, and are significantly sicker than other asthma patients, with attendant increases in morbidity and mortality. In these patients, the management areas summarized in table 1 should be fully explored to determine whether asthma is the correct diagnosis and whether the best care is being given.