How to Approach Unresponsive Asthma

Despite an improved understanding of asthma and the many new treatments available for its control, a surprising number of patients appear refractory or unresponsive to the best management. Most patients with asthma have mild or moderate disease that responds well to simple treatments. Unfortunately, a proportion of patients suffer persistent symptoms, have recurrent exacerbations or have sub-optimal lung function, despite physicians’ efforts. Many terms are used to refer to failure to respond to asthma therapy, including “difficult asthma” and “refractory asthma.” We will adopt here the term “unresponsive asthma” to address this subgroup of patients. The following review offers a sequence of questions designed to help the practitioner learn why his or her patient with asthma is apparently unresponsive to treatment.