Specialist referral

Severe asthma is described as asthma that remains uncontrolled despite optimised therapy, including management of comorbidities and other contributing factors. Refer patients with severe asthma to a respiratory physician for assessment and management.

In addition to severe asthma, specialist consultation is recommended:

• for asthma associated with anaphylaxis
• following a life-threatening asthma exacerbation requiring hospitalisation
• for frequent asthma-related emergency-department or urgent general practitioner visits
• asthma in patients who appear to have good lung function but experience frequent symptoms or exacerbations
• for patients with poor self-management skills (if referral to a practice nurse or asthma educator has not helped)
• if there is doubt about the diagnosis of asthma
• for suspected occupational asthma.

Specialist management of asthma includes reassessment of the diagnosis, assessment of the asthma phenotype, assessment of adherence, inhaler technique and comorbidities, and education about self-management skills. Additional treatments are individualised and consider all aspects of the patient’s condition—see Specialist treatments for severe asthma. Specialist management may be best achieved in a multidisciplinary severe asthma clinic.

For detailed information about severe asthma, see the Severe Asthma Toolkit, an Australian resource for assessing and managing severe asthma.