Difficult to control asthma

Around 12 per cent of people with asthma have 'difficult to control' asthma, where they often have symptoms and asthma attacks.

Around 17 per cent of people with asthma often have asthma symptoms and frequent asthma attacks. If this is happening to you, there are two very different reasons why:

  1. you might have difficult to control asthma
  2. more rarely, you might have a specific type of asthma called 'severe' asthma’. You can find out more about severe asthma here

What is difficult to control asthma?

Around 12 per cent of people with asthma have 'difficult to control' asthma. This means they have difficulty breathing almost all of the time and often have potentially life-threatening asthma attacks even though they're on high doses of medication.

There are lots of different reasons why you might have asthma that's difficult to control. These include:

  • having other long term conditions that make it harder to manage your asthma, for example a heart condition or diabetes
  • being a smoker, which makes asthma symptoms worse and stops asthma medicines working as well
  • finding it hard to get into a good routine of taking your inhalers and other asthma medicines regularly and using a good inhaler technique. This means you're not getting the right dose at the right time to help get your symptoms under control.

But my symptoms are so bad - isn't that severe asthma?

Having bad asthma symptoms for a short time - perhaps as a result of a cold virus, or hay fever, or when you're going through a period of stress - can happen to anyone with asthma.

But if you're having bad asthma symptoms a lot of the time or you're finding it hard to manage your asthma well, it doesn’t mean you have the type of asthma that can be medically classified as ‘severe’. Even if your GP or asthma nurse told you you have 'severe asthma symptoms' that are potentially life-threatening if not treated, it doesn't mean you have a diagnosis of severe asthma. The percentage of people with 'severe asthma' is very low - about five per cent. Most people with bad symptoms have asthma that's difficult to control.

But I always need to take my reliever inhaler - I must have severe asthma

If you need to keep taking your blue reliever inhaler this doesn't necessarily mean you have severe asthma but it does mean your asthma is not well controlled. If your asthma symptoms are getting worse you should see your GP or asthma nurse to talk about your asthma care and how you can get back in control. It may be that your medicines need to be reviewed, or that you need to get into a good routine to help you remember to take them.

But most of the time, difficult asthma symptoms can be treated, and, with the right medicines and support, you can get back on track with your asthma.

Use a written action asthma plan to help you manage your asthma well.

If you're still always having bad asthma symptoms, your GP may refer you to a specialist clinic for tests to see if your asthma is the type of asthma that can be medically classified as 'severe'. Other things will also be taken into account, such as any other conditions or allergies you might have.

Don't put up with difficult asthma symptoms

Some people who have a lot of bad asthma symptoms and frequent asthma attacks may still not be given a diagnosis of 'severe' asthma but told they have difficult to control asthma instead. But this still means you probably need extra support and treatment until you get back on top of your asthma. 

If you're having bad asthma symptoms, don't ignore them - symptoms are a sign that your asthma is not well controlled and that you're at risk of an asthma attack so it's important to do something about them.

In the short term your GP or asthma nurse might prescribe a course of steroid tablets to reduce the inflammation in your lungs and help your asthma get back under control. But it’s important to find long term solutions too, so you don’t carry on with difficult symptoms.


Your GP or asthma nurse can talk to you about:

  • sticking to a good medicine routine
  • the best way to take your inhalers
  • what situations or triggers make your asthma worse, including work
  • how you cope with your asthma triggers
  • other types of support, for example stop smoking advice

You might be prescribed extra medicines to take every day alongside your usual preventer inhaler to help you manage your asthma better. For example:

Whenever your GP makes a change to your usual prescription, you should get another appointment 4-8 weeks later to check the new meds are working and are right for you. You can help things along by sticking to your new treatment plan exactly as prescribed, and keep a diary of any symptoms or improvements. This helps you and your GP know if the new treatments are working well for you or not.  

Whatever treatment you're given, it can only work if you stick to it as prescribed

It's not unusual for people with long term conditions such as asthma to find it difficult or worrying to have to take medicines all the time. Perhaps you don't believe you really need your asthma medicines, or you're worried about the side effects and it puts you off. If concerns about your asthma medicines mean you're taking less of them, skipping doses or even stopping taking them all together, this is likely to make your asthma worse. And if you're always forgetting to take your asthma medicines or not taking your inhaler in the best way, you won't be doing a true test of the treatment prescribed to you.

Most people with difficult to control asthma can get back to good asthma control with the help of the right asthma medicines and by following the usual asthma management advice.

Last updated December 2017

Next review due October 2019