Difficult asthma assessment

Assessment of difficult-to-treat asthma.

Is it asthma?
Objective evidence of variable airflow obstruction, and when: []
Alternative or additional diagnoses considered: [inducible laryngeal
obstruction, dysfunctional breathing, bronchiectasis, COPD, heart failure,
ABPA, eosinophilic granulomatosis with polyangiitis, tracheobronchomalacia]
Investigations done to exclude them: []

Is the treatment being taken?
Prescribed regimen: []
Prescription collections in the last 12 months: [preventer collections of 12]
Inhaler technique observed today: [adequate, or the specific error seen]
Adherence discussed without blame, and what the patient says: []
FeNO suppression test done: [yes with result, or no]

What else is driving it?
Nasal disease or polyps: []
Reflux: []
Obesity, BMI []
Obstructive sleep apnoea, Epworth []
Smoking or vaping, pack-years []
Occupational exposure, and whether symptoms improve away from work: []
Aspirin or NSAID sensitivity: []
Beta blockers: []
Anxiety, depression or panic: []
Ongoing allergen exposure at home, including pets and damp: []

Attack and steroid burden:
Oral steroid courses in the last 12 months: []
Maintenance prednisolone, dose and duration: []
Cumulative steroid exposure and its consequences: [bone density, diabetes,
cataract, weight, adrenal suppression]
Admissions, HDU or ITU care: []

Phenotype:
Highest blood eosinophil count, and when taken: [] x10^9/L
FeNO off or on steroids: [] ppb
Total IgE [] kU/L, aeroallergen specific IgE or skin prick: []
Aspergillus IgE and IgG: []
Age of onset: []
Sputum culture: []
CT chest: []

Impression:
[difficult-to-treat asthma with modifiable factors, or severe asthma meeting
criteria for specialist therapy]

Plan:
1. []
2. Referral to severe asthma multidisciplinary team: [yes or no, with reason]
3. Biologic considered: [drug and the eligibility criterion met, or not yet]