For people with uncontrolled asthma, NICE asks prescribers to consider possible reasons for this before starting or adjusting medicines. Reasons could include:2

·       alternative diagnoses;

·       lack of adherence;

·       suboptimal inhaler technique;

·       smoking (active or passive);

·       occupational exposures;

·       psychosocial factors;

·       seasonal or environmental factors.

If medicine needs to be initiated or adjusted, then the patient should be reviewed 1-2 months later to see what the response to treatment has been.

NG80 then sets out pharmacological treatment pathways for different age groups. For adults aged 17 or over and for children and teenagers 5-16 years, the recommendations relate to those with newly diagnosed asthma or asthma that is uncontrolled on their current treatment.

For children under 5 years, it can be difficult to confirm an asthma diagnosis so the recommendations apply for suspected, as well as confirmed, asthma. However, a child with suspected asthma should have this confirmed with objective tests once they are able to.