Dr Andy Whittamore, Asthma UK’s in-house GP, says: "If your asthma is difficult to control even though you’re taking your medicines as prescribed, your GP or asthma nurse can 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'd benefit from a specialist review with a consultant. You may have a type of asthma that responds to some of the new treatments. These can dramatically improve asthma symptoms for some people."
Guidelines suggest that your GP should consider referring you to a specialist if:
- the diagnosis of asthma is in doubt
- they are considering whether you have another condition (which may be in addition to 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 doses of add-on treatments
- you have had a life-threatening asthma attack
- your GP suspects you may have occupational asthma.
The majority of people are referred by their GP to an asthma or respiratory specialist in their local hospital. Some people might be referred to a specialist asthma care centre by their hospital consultant.
Be honest about how you’re managing your asthma
Before you make your case for referral it’s worth spending a bit of time thinking about how you manage your asthma.
This way you can be sure 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 three asthma-tracking tools and taking them along to your appointment.
This can help you show that despite using your medicines as prescribed, and following healthy lifestyle recommendations, your symptoms are not as well controlled as they could be and you'd like some more help.
- Use a peak flow diary so you have a visual record of how your lungs are working over time.
- Keep 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.
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, and perhaps discuss what you want to ask your GP with them beforehand.
Try writing down some phrases before you go and use them alongside your peak flow diary, action plan and symptom calendar during your consultation. Here are some examples:
- "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 have a specialist review.
"It can be easy to think there's 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. Not taking them could also make your airways more likely to react when you come into contact with your triggers," says Dr Andy.
Not all requests for referral to specialist care are successful. 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 specialist support available to you at this time, or until you meet certain criteria.
“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 Dr Andy.
It may help to talk the situation through with one of our friendly asthma nurse specialists on our Helpline on 0300 222 5800 (9am - 5pm; Mon - Fri). Or you can message them via WhatsApp on 07378 606 728
Last updated January 2020
Next review due January 2023