Refer a patient with suspected asthma to secondary care if there is diagnostic uncertainty in children or adults NICE CKS.
If an adult has suspected occupational asthma that cannot be confirmed or managed in primary care, referral is recommended NICE CKS.
Patients with persistent symptoms and/or exacerbations despite good adherence to optimized ICS-containing treatment for 3–6 months should be referred for specialist assessment NICE CKS.
Individuals with severe asthma, difficult-to-treat asthma, or a history of near-fatal asthma exacerbation should be referred and remain under specialist supervision indefinitely NICE CKS.
Children under 5 years with symptoms not responding to initial treatment, or with hospital or multiple emergency admissions for wheeze, should be referred to a specialist respiratory paediatrician NICE CKS.
Patients with clinical features of both asthma and COPD, or where there is diagnostic uncertainty, should be referred to secondary care NICE CKS.
In cases where there is suspicion of alternative diagnoses or other complicating factors such as food allergy or adverse treatment effects, referral is advised NICE CKS.