The majority of people are referred by their GP to an asthma/respiratory specialist in their local hospital. Some people might be referred to a specialist asthma care centre by their hospital consultant.
When are you more likely to be referred to specialist care?
"If your asthma is still difficult to control even though you’re taking your medicines as prescribed, then your GP or practice asthma nurse can to talk to you about add-on treatments, and discuss triggers and other conditions which might be making your symptoms worse. They can also consider whether you would benefit from a specialist review with a consultant who can prescribe additional treatments," says Andy Whittamore, Asthma UK’s in-house GP.
The British Thoracic Society (BTS) guidelines suggest that your GP should consider referring you to a specialist if:
- the diagnosis of asthma is in doubt
- they are considering another diagnosis (which may be as well as the asthma) that requires more specialist investigation
- your asthma can only be controlled with regular or frequent oral steroids
- you have frequent symptoms even though you’re taking high levels of add-on treatments
- you have had a life-threatening asthma attack in the last 10 years
- your GP suspects you might have occupational asthma.
Making your case for referral
Be honest about how you’re managing your asthma
Before you put your case for referral it’s worth spending a bit of time thinking about how you manage your asthma. This way you can be clear that you’re doing everything you can to stay well. Be honest with yourself about how you’re taking your prescribed asthma medicines, and any lifestyle issues that may be affecting your asthma, such as smoking.
Do you feel confident that:
- you have a good routine with your asthma medicine and know how to use your inhalers properly
- you get the most out of regular annual reviews with your GP or asthma nurse
- you follow your written asthma action plan and know what to do when symptoms get worse?
Help your GP to see how your asthma’s been
You’ll help your case if you have a good track record of being open and honest about how you’re managing your asthma between appointments. Before you’re even considered for a referral to specialist care your GP will want to be sure that you’re doing everything you can to control your asthma.
You might find it easier to give your GP all the information they need about how your asthma’s been by using the following and taking them along to your appointment. This can help you discuss the fact that despite using your medicines as prescribed, and following healthy lifestyle recommendations that can help your asthma, your symptoms are not as well controlled as they could be and you would like some more help.
- Keep a peak flow diary so you have a visual record of how your lungs are working over time.
- Use a medicines diary to show that you have been taking your asthma medicines and using your written action asthma plan.
- Keep a chart or calendar of all your symptoms and when you have them, remembering to include a note about how they affected your daily life, for example if you needed to take time off work and when you’ve needed to use your reliever inhaler.
“I’ve created a chart on my computer to help me stay organised with my asthma medicines. It helps me to keep track of what doses I need and when to take them. It also includes a list of my allergies and medical conditions. I’m always updating it and print it off so I can take it to every asthma review or hospital appointment," - Julia Kerr, 29.
Be clear about why you think you need a referral
It can sometimes help to have a think about what you actually want to say before you get to the appointment, so that you can approach things calmly. Don’t forget you can take a friend or family member for support – perhaps talk through with them what you want to ask before you go too.
Try writing down some phrases before you go and use them alongside your peak flow diary, action plan and symptom calendar during your consultation.
- "As you can see from my medicines diary, I’ve been taking all my medicines as prescribed. However I’m still having problems controlling my asthma in spite of everything I’ve been doing."
- "I’ve recorded all my symptoms and all my asthma attacks here in my symptom diary. I’ve been admitted to hospital X number of times over the last X months. I’ve also been back to see you about my asthma X times."
- "I’ve been doing all I can to avoid my triggers, I don’t think there is anything else I can do to self-manage. I’d like to request some specialist advice about other treatments or different approaches, to help me control my asthma better."
- "I’ve been recording my peak flow scores on a chart and for some time I’ve been getting scores below my personal best."
Make it clear to your GP that you understand that it’s important to carry on with your current treatment plan, and stick to your written asthma action plan until you can be reviewed.
"It can be easy to think there is no point taking medicines if your symptoms are not well controlled – but without those medicines the inflammation in your airways is likely to increase and make your symptoms even worse – as well as making them more likely to react when you come into contact with your triggers," says our in-house GP Dr Andy Whittamore.
What you can do if your request is refused
Not all requests for referral to specialist care are successful.
“If for any reason 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," says Andy Whittamore, our in-house GP.
If you're still not satisfied, or if you still believe specialised care is the only way to help improve your asthma control, we want to hear from you. You can also get advice on how to make a complaint.
This may be a difficult time as you try to control your asthma day-to-day, while also coping with the stress of learning that there may not be any extra support from the NHS available to you at this time, or until you meet certain criteria. It may help to talk the situation through with one of our friendly asthma nurse specialists via our Helpline on 0300 222 5800 (9am - 5pm; Mon - Fri).
Last updated September 2016
Next review due September 2019