Difficult to manage asthma desktop guide: referral letter (UK version) Key information to include in a referral letter
for a patient with difficult-to-manage asthma

To get the most value from a referral for a Example of a referral letter that includes
patient with difficult-to-manage asthmaaim to include the following information in all of the key pieces of information
• Reason for referral today / current concern Here is an example of a letter that includes all of the (for example: poor control despite optimal information that a secondary care respiratory specialist wants treatment, to confirm diagnosis of asthma, to have for a patient referred for difficult-to-manage asthma: for management suggestions; what isconcerning or bothering the patientregarding their asthma) diagnosis was made if available(for example: symptoms; demonstration of I would value your assessment of this 42 year-old woman with asthma because she has had several severe exacerbations in the last two years She was diagnosed with asthma in childhood based on spirometry and has been on inhaled steroids more or less continuously since then, but in the past 8 to 10 years she has become more difficult to manage, exacerbations in the last year, steroid use, hospitalisation, need for mechanicalventilation, life-threatening asthma She is currently being prescribed Seretide 500 Accuhaler twice daily, and Singulair 10mg at night but continues to require a Ventolin inhaler weekly. In addition, she has had two hospital admissions and at least six additional visits to Accident and Emergency and our practice with • Inhaler technique checked by observing She receives steroids on each of these occasions and I have been (Link to Difficult to manage asthma resources when online ) concerned about her level of steroid exposure. Because of this, I • Adherence with asthma therapy checked reviewed these episodes and they do sound like asthmatic exacerbations with appropriate physical signs and reduced peak flow.
On at least one of these presentations, she performed spirometry in the practice and this demonstrated airflow obstruction.
Her Seretide and Singulair prescription records are consistent with good prescription filling and her inhaler technique seems excellentbased on observation.
• Smoking history; other domestic / work She has no obvious co-morbidities other than some background rhinitis, which we have treated effectively with Nasonex. Her body mass index (BMI) is 26 and she has never smoked tobacco. There has been no • Other factors in a patient’s life (such as obvious change in her circumstances in the past few years and the depression, psychological factors etc) that home situation seems fairly stable. She is a housewife.
may affect asthma management, which thedifficult-to-manage asthma service could She had a normal chest X-ray six months ago and I have requested a bone scan because of her significant steroid exposure.
information, consider if it can be gatheredbefore sending the referral because this willimprove the effectiveness of the referral.


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