Home - Difficult to manage asthma

Difficult to manage asthma is asthma that either the patient or the clinician finds difficult to manage.

 A patient with difficult to manage asthma has daily symptoms and regular exacerbations despite apparently best treatment.  There are two main groups of patients with difficult to manage asthma:

  •  People whose asthma has been controlled in the past but who have now lost control
  •  People whose asthma has never been controlled

Investigations and management should aim to:

  • Identify when asthma control is lost / has never been achieved by prompt and effective monitoring using the SIMPLES mnemonic to help
  •  Gain/regain control and then maintain control of asthma with effective, well- tolerated treatment

Desktop helper

Download our practical "how to" guide in a variety of languages, validated and adapted by our member groups here .  Available in:

  • English
  • French
  • German
  • Greek
  • Italian
  • Polish
  • Portuguese
  • Russian
  • Spanish


Tools, resources and references

These resources are linked to the difficult to manage asthma desktop helper and are listed in the order of its recommendations.

Click here to view the practical tools and resources

Difficult to manage asthma desktop helper references

Referral letter for difficult to manage asthma (UK version)
Referral letter for difficult to manage asthma (outside UK)

Video describing how to use SIMPLES in practice by Dr Dermot Ryan

Primary Care Respiratory Journal September 2013 Ryan D, Murphy A, Stallberg B, Baxter N, Heaney LG. ‘SIMPLES’: a structured primary care approach to adults with difficult asthma. Prim Care Respir J 2013;22(3):365-373. DOI: http://dx.doi.org/10.4104/pcrj.2013.00075