Systematic assessment of difficult-to-treat asthma

Eur Respir J. 2003 Sep;22(3):478-83. doi: 10.1183/09031936.03.00017003.


Five per cent of asthmatics remain symptomatic despite high-dose treatment. The aim of the study was to investigate how often such difficult-to-treat asthma is due to intractable asthma, misdiagnosis, non-adherence with therapy, or psychiatric problems. Difficult asthma was defined as persistence of symptoms despite treatment at step 4 of British guidelines or requirement for long-term oral glucocorticoids (step 5). One-hundred patients with a respiratory physician diagnosis of asthma were investigated in a single tertiary respiratory unit in an open and descriptive study. Twelve of the patients studied did not have asthma and a further seven had additional diagnoses. Of the remainder, 55 had an asthma diagnosis confirmed by demonstration of reversible airflow narrowing or peak flow variability, whilst 20 did not. Non-compliance with prednisolone therapy was more frequent in the 55 with confirmed asthma (nine of 18 prescribed oral prednisolone at a dose of > or = 15 mg x day(-1)) and was not detected in the "unconfirmed asthma" group. There were no other significant differences between these groups. A major psychiatric component was detected in 10 patients. Systematic evaluation of difficult asthma is useful as it can identify alternative or additional diagnoses, psychiatric illness or nonconcordance with therapy in a substantial proportion of cases (32% in the present series).

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Administration, Oral
  • Adult
  • Anti-Inflammatory Agents / therapeutic use
  • Asthma / diagnosis*
  • Asthma / drug therapy
  • Asthma / psychology
  • Beclomethasone / therapeutic use
  • Female
  • Glucocorticoids / therapeutic use
  • Humans
  • Hypersensitivity, Immediate / diagnosis
  • Lung Diseases / diagnosis
  • Male
  • Middle Aged
  • Patient Compliance
  • Prednisolone / therapeutic use
  • Pulmonary Disease, Chronic Obstructive / diagnosis
  • Respiratory Function Tests


  • Anti-Inflammatory Agents
  • Glucocorticoids
  • Prednisolone
  • Beclomethasone