What are the recommended referral criteria for patients with asthma who are not responding to standard treatment in primary care?

Refer patients with asthma to a specialist respiratory service if there is diagnostic uncertainty, persistent symptoms and/or exacerbations despite good adherence to optimized ICS-containing treatment for 3–6 months, or if they have severe or difficult-to-treat asthma, or a history of near-fatal asthma exacerbation ¹.

In cases where asthma is not responding to standard treatment, consider referral for further investigation, phenotyping, and additional treatments such as biologic therapy targeting immune pathways for severe asthma ¹.

Children under 5 years with symptoms not responding to initial treatment, especially if they have had hospital or multiple emergency admissions, should be referred to a specialist respiratory paediatrician ¹.

Patients with suspected occupational asthma or where occupational factors may influence control should be referred to an occupational asthma specialist, especially if symptoms persist despite optimal treatment ¹.