Difficult to control asthma

Asthma symptoms can sometimes get worse for a short time. This could be because you have a cold, you’re stressed, or your hay fever’s bad.  

But if you’re having asthma symptoms three or more times a week, you could have what doctors call ‘difficult asthma’, or ‘difficult to treat’ asthma.

Studies suggest that around 17% of all people with asthma have asthma that’s difficult to control.

How is difficult asthma different to severe asthma? 

Difficult asthma is not the same as severe asthma. Severe asthma is a type of asthma that doesn’t respond to the usual asthma treatments.

If you have difficult asthma, it’s possible to get back good control of your symptoms with the right support.

Around 4% of people with asthma have ‘severe asthma’. You can read more about severe asthma.

You can also use our interactive tool to check if you could have severe asthma and find out how to ask for a referral.

Most people with asthma are able to manage their symptoms with a preventer inhaler every day, and occasional reliever medicine if symptoms flare up. Good control should mean few or no symptoms, and no limits on your daily life because of your asthma.

If you answer yes to one or more of these questions, it’s a sign that your asthma is not as well controlled as it could be:

• Are you getting symptoms three or more times a week?
• Do you use your reliever inhaler (usually blue) three or more times a week?
• Do you wake up at night because of your asthma one or more nights a week?
• Do you find it hard to get on with things during the day because of your asthma, whether that’s exercising, playing with your children, or going to work? 

• Smoking, or breathing in others’ smoke, makes asthma symptoms worse and stops asthma medicines working as well.
• Being exposed to your asthma triggers a lot over a long period of time
• Having other related conditions, such as acid reflux or a food allergy can make it harder to manage your asthma, and put you at risk of asthma attacks.
• Managing other long-term conditions alongside your asthma, including anxiety and depression, can make it harder to manage your asthma.
• Female hormones can make asthma symptoms harder to manage around periods or during menopause.
• Being overweight (obese) increases your risk of asthma symptoms.
• Not taking your preventer inhaler every day as prescribed means your airways are not protected and you’re more at risk from symptoms and asthma attacks.
• Poor inhaler technique increases your risk of asthma attacks because it means you’re not getting enough medicine into your lungs. Watch our inhaler videos.

Most of the time, with the right medicines and support you can improve your asthma symptoms.  

You can help things along by:

• taking your preventer inhaler every day, and any other medicines and treatments you’ve been prescribed
• using a written asthma action plan agreed with your GP or asthma nurse. Keep it up to date by taking it along to each appointment.
• keeping a peak flow diary alongside a diary of your triggers and symptoms.
• getting support to quit smoking and avoiding being around others who smoke
• being open about how you feel – stress, anxiety and depression are common for people with difficult asthma.

If you’re worried your asthma is difficult to control, it’s important to make an appointment with your GP or asthma nurse.

At your appointment, your GP or asthma nurse can:

• talk about the medicines or doses you’ve been prescribed
• check and update your asthma action plan
• check your inhaler technique (your pharmacist can also do this)
• check your peak flow and talk to you about monitoring your peak flow at home
• talk through anything making your asthma worse, including possible allergies or triggers, including triggers at work
• discuss any other health conditions you’re managing alongside your asthma
• give stop smoking advice if you smoke or advice about exercising or losing excess weight if this would help you
• give advice about breathing, and suggest breathing exercises
• answer any questions you may have – write these down before you go so you don’t forget anything you want to ask

In some cases, there may be other conditions causing your symptoms. Your GP or asthma nurse can check to make sure you’ve been correctly diagnosed with asthma.

If you’re taking your preventer inhaler every day as prescribed, and avoiding your triggers as much as possible, but your asthma is still difficult to control, your GP or asthma nurse may decide you need a different treatment plan.

This may include:

• add-on medicines such as a long-acting bronchodilator, or montelukast (a preventer tablet), to take alongside your usual preventer inhaler
• a combination inhaler or MART – maintenance and reliever therapy
• a higher dose in your preventer inhaler
• a short course of steroid tablets to treat the extra inflammation in your airways
• a device that’s easier for you to use or a spacer

“You need to take your medicines exactly as prescribed to get good results and see your symptoms improving,” says Dr Andy Whittamore, our in-house GP and Clinical Lead. “If you’re finding it hard to stick to a good routine for taking your medicines, or you’re worried about side effects, talk to your GP or asthma nurse as soon as possible.”

Whenever your GP makes a change to your usual prescription, you should get another appointment four to eight weeks later to check the new medicines are working and are right for you. 

If you’re still always having asthma symptoms, even though you’re taking all your medicines as prescribed, using the correct inhaler technique, and avoiding your triggers as much as possible, ask your GP for a referral to a specialist clinic for tests to see if you have severe asthma.