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 NICE CKS.
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 NICE CKS.
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 NICE CKS.
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 NICE CKS.