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
Download our practical "how to" guide in a variety of languages, validated and adapted by our member groups here Available in:
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.
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: 10.4104/pcrj.2013.00075
Difficult to manage asthma - Position Paper for policy makers
Advisory panel and authors
This programme has been taught in a Teach the Teacher programme.
Its adaptation for the Dutch context published:
Honkoop PJ, Pinnock H, Kievits-Smeets RMM, Sterk PJ, Dekhuijzen PNR, in ’t Veen JCCM. Adaptation of a difficult-to-manage asthma programme for implementation in the Dutch context: a modified e-Delphi. npj Prim Care Respir Med [Internet]. 2017;27(May 2016):16086. Available from: http://www.nature.com/articles/npjpcrm201686