What criteria should I use to determine whether to refer a patient with suspected asthma to secondary care?

Refer a patient with suspected asthma to secondary care if there is diagnostic uncertainty in children or adults ¹.

If an adult has suspected occupational asthma that cannot be confirmed or managed in primary care, referral is recommended ¹.

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 ¹.

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 ¹.

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 ¹.

Patients with clinical features of both asthma and COPD, or where there is diagnostic uncertainty, should be referred to secondary care ¹.

In cases where there is suspicion of alternative diagnoses or other complicating factors such as food allergy or adverse treatment effects, referral is advised ¹.