© 2003 BMJ Publishing Group & British Thoracic Society
EDITORIAL
Difficult asthma
Difficult asthma
Department of Respiratory Medicine, Norfolk and Norwich University Hospital NHS Trust, Colney Lane, Norwich NR4 7UY, UK; brian.harrison@nnuh.nhs.uk
It is hoped that the systematic approach to managing patients with therapy resistant asthma reported in this issue of Thorax will encourage others to study this difficult group of patients and to test hypotheses about improving their management.
Keywords: difficult asthma; asthma
| The first 150 words of the full text of this article appear below. |
Central to any description of difficult asthma1 is a disconnection between expectations and outcome. Difficult asthma may be defined as being present in a patient with a confirmed diagnosis of asthma whose symptoms and/or lung function abnormalities are poorly controlled with treatment which experience suggests would usually be effective. This immediately begs the questions of who confirmed the diagnosis, how the diagnosis was made, whether the symptoms and lung function abnormalities are due entirely to the diagnosis of asthma, and whose "experience" is being used. It is certainly wise when seeing a patient with difficult asthma to question the diagnosis. If it is confirmed, are there any co-existing organic respiratory conditions such as COPD or bronchiectasis or psychogenic conditions such as hyperventilation or vocal cord dysfunction with wheeze? If there are co-existing problems, are these the main cause of the uncontrolled symptoms as in pseudo-steroid resistant asthma?2 It
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