Systematic Assessment of Difficult-to-Treat Asthma: Principles and Perspectives

Mark Hew, Andrew Menzies-Gow, James H. Hull, Louise Fleming, Celeste Porsbjerg, Anneke Ten Brinke, David Allen, Robin Gore, Tunn Ren Tay

Research output: Contribution to journalArticleOtherpeer-review

31 Citations (Scopus)


Difficult-to-treat asthma affects a minority of adults and children with asthma but represents a challenging mix of misdiagnosis, multimorbidity, inadequate self-management, severe airway pathobiology, and treatment complications. Management of these patients extends beyond asthma pharmacotherapy, because multiple other patient-related domains need to be addressed as well. Such complexity can hinder adequate clinical assessment even when performed in specialist practice. Systematic assessment undertaken by specialized multidisciplinary teams brings a broad range of resources to bear on patients with difficult-to-treat asthma. Although the concept of systematic assessment is not new, practices vary considerably and implementation is not universal. Nevertheless, assessment protocols are already in place in several institutions worldwide, and outcomes after such assessments have been highly encouraging. This review discusses the rationale, components, and benefits of systematic assessment, outlining its clinical utility and the available evidence for improved outcomes. It describes a range of service configurations and assessment approaches, drawing examples from severe asthma centers around the world to highlight common essential elements. It also provides a framework for establishing such services and discusses practical considerations for implementation.

Original languageEnglish
Pages (from-to)2222-2233
Number of pages12
JournalJournal of Allergy and Clinical Immunology: In Practice
Issue number7
Publication statusPublished - Jul 2020


  • Adherence
  • Comorbidities
  • Diagnosis
  • Difficult asthma
  • Personalized medicine
  • Protocolized
  • Severe asthma
  • Treatable traits

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