Specialist asthma care

Specialist asthma care is when you’re referred to an asthma specialist or a specialist care centre for asthma treatment. Most people with asthma are more likely to get referred to a specialist in their local hospital or clinic, rather than a specialist centre.  

You may get a referral to a specialist if:  

• your asthma diagnosis is unclear
• your symptoms could be caused by another condition
• your GP thinks you have occupational (work-related) asthma
• your child is unable to do asthma tests, or their treatment is not working.

Your GP may also refer you to a specialist if your asthma symptoms are hard to control even though you're using your inhalers and medicines correctly.

For example, if in the last 12 months you:

• have had lots of symptoms even though you're taking your medicine as prescribed. Your GP may ask you questions from the Asthma Control Test to see how well controlled your asthma has been during the last four weeks.
• have stayed in hospital or went to A&E at least once for your asthma
• were prescribed six or more blue reliever inhalers in the past six months
• needed two or more courses of steroid tablets
• have been on maintenance (ongoing) steroids tablets for your asthma.

Who can get a referral to a specialist asthma centre?

At the moment, very few people are referred to specialist asthma care centres. There are only a small number of centres across the UK. 

What do specialist care centres do?

For a centre to be called a specialist asthma centre, it must:

• have access to a team of respiratory and other specialists
• be able to offer specialist asthma tests
• be able to offer treatments such as biologic therapies and bronchial thermoplasty
• be led by at least two consultant respiratory physicians with a specific interest in severe asthma.

Specialist asthma centres aim to:

• confirm your asthma diagnosis and the type of asthma you have
• identify any work-related asthma triggers
• diagnose any other conditions that might be giving you asthma-like symptoms
• diagnose and treat any conditions you have alongside your asthma that could be making your symptoms harder to manage
• treat any conditions linked to your severe asthma, such as sleep apnoea
• help you with any side effects
• look at ways to help you avoid long-term use of high-dose oral steroids
• provide access to specialist treatments if you could benefit from them
• make sure you’re supported to cut your risk of asthma attacks, and reduce the need for hospital stays, including taking all your asthma medicines as prescribed
• help you find ways to remember to take your asthma medicine.

Before you’re considered for a referral to specialist asthma care, your GP will want to be sure that you’re doing everything you can to control your asthma.

It can help you and your GP if you write things down:

• Keep a peak flow diary so you have a record of how your lungs are working.
• Use a diary to show that you’ve been taking your asthma medicines and using your written action asthma plan.
• Keep a diary of all your symptoms, any possible triggers and when you’ve needed to use your reliever inhaler.  Remember to include a note about how symptoms affected your daily life - for example, if you needed to take time off work.

This will help your GP or other healthcare professional know if you’d benefit from a referral to specialist care.

If your request is refused   

Not all requests for referral to specialist care are successful.

“If your request has been refused, go back to your GP for an explanation and make sure you ask for suggestions and advice on how you can manage your asthma going forward. Sometimes the specialist will suggest different treatments or tests. Following this advice may help improve your asthma control so it's worth doing” says Dr Andy Whittamore, GP.

Once you’ve been referred for specialist care, you’ll receive an appointment letter or details to book an appointment online. You should read this through thoroughly before going to your first appointment.

Before your appointment

You may want to:

• add the appointment to your calendar or diary
• take videos when you have asthma symptoms to show your healthcare professional, but do not delay taking any reliever medicine
• plan how you will get to the appointment
• plan who will come with you, such as a family member or friend, if you want extra support
• make a list of questions or concerns about your specialist care.

At your appointment  

Don’t forget to bring:

• the letter confirming your appointment
• your written asthma action plan if you’ve got one, or any apps you use to manage your asthma
• your symptom diary and peak flow diary if you’ve been keeping one
• your asthma medicines and details about how long you've been taking them
• details about any inhalers you've taken in the past, how long you were on them and if they caused any side effects
• the names and doses of any other medicines you’re taking, such as antibiotics
• details about courses of steroids you’ve taken  
• dates you’ve been admitted to hospital or needed to go to A&E for your asthma
• something to make notes with. This might be a pen and paper, or an app on your phone.

If you’re referred to a hospital or clinic, you may need ongoing follow-up care. You could also have one appointment and then be discharged back to your GP. It depends on the treatment you need.

Ongoing specialist treatment

If you have severe asthma, you may need to stay under the care of a specialist asthma centre. If you’ve had an asthma attack that meant you needed intensive care, your specialist consultants may recommend that you benefit from specialist asthma care long term.

Leaving specialist care

There may be a time when your specialist team feels you can manage your asthma well under the care of a consultant in your local hospital, instead of at the specialist asthma centre, or even with support from your GP, particularly if:

• you’re managing your asthma symptoms well by following an updated asthma action plan and taking your asthma medicines regularly, as prescribed
• you’re now able to manage another condition that was making your asthma symptoms worse before. Read more about other health conditions related to asthma.
• you know the specific asthma triggers that you can avoid.