General practitioners' understanding of severe and difficult asthma: A qualitative study

To explore how severe asthma and difficult asthma are perceived by general practitioners.

Qualitative grounded theory method was used. 13 GPs were interviewed and the interviews recorded, transcribed and analysed for themes.

There were different perceptions of 'severe' asthma and 'difficult' asthma from most GPs. The main difference was that 'severe' asthma was understood in more medical terms where 'difficult' asthma tended to be asthma that was difficult to get under control due to a variety of reasons including social and psychological patient variables. Two GPs refused to use the term 'difficult' asthma, one because of the excessive numbers of terms being used in asthma, and the other because of its pejorative nature.

These different perceptions confirm that there is no one agreed definition for severe asthma nor difficult asthma. However, difficult asthma in most cases had a broader definition, including psychological and social implications and factors, than severe asthma.