This is a specialist clinic for people who have given a label of asthma, who continue to have difficult symptoms of breathlessness, cough and/or wheeze despite being on regular asthma medication.
It is a multidisciplinary clinic, meaning you see several healthcare specialists, and receive several assessments in one visit. This should reduce the number of hospital appointments that you need. It also allows the specialist health care professionals to work together and discuss their findings, to explore the best treatment options for you.
At the end of the clinic, a respiratory doctor will talk to you about assessment findings and treatment options. You can work together to plan your next treatment steps.
If you have been referred from a different health centre, all assessment findings, and treatment plans will be fed back to your local respiratory team, and GP.
You will see expert healthcare professionals who specialise in asthma. The lead respiratory consultants for these clinics are Dr Sean Parker and Dr Nicola Green.
Below is a summary of the key roles of the different professionals in this clinic:
- Respiratory doctor: To review your medications, assessment findings, and talk about different treatment options.
- Respiratory nurse: To review your inhaler technique, talk about any challenges taking medications, and explore ways to support your asthma control
- Speech and Language Therapist (SLT): To assess any throat (laryngeal) disorders that may be contributing to symptoms of cough and breathlessness
- Physiotherapist: To assess the co-ordination of your breathing muscles, and how fast you are breathing
- Pharmacist: To review your medication regime, and advise on alternative treatments if appropriate
- Respiratory physiologists: For lung function tests to assess how well your lungs are working.
People are usually referred to this service from specialist respiratory doctors. Some people are referred from their GP, or asthma nurses, physiotherapists or Speech and Language Therapists.
We accept referrals from out of area, including for a second opinion.
You will receive an appointment letter in the post. Sometimes if there is a last-minute cancellation, you will receive a telephone call to see if you could come in at late notice.
The asthma clinic appointment usually lasts 2-3 hours, this will include all assessments, time waiting for the health professionals to talk about your assessment findings, and a discussion between you and the respiratory doctor at the end to summarise findings and make a treatment plan.
Please bring inhalers to your appointment
The health professionals will ask questions to better understand your symptoms, what could be making them worse, and what could be done to reduce them.
Key questions will relate to:
- What your main symptoms are
- Whether you have noticed any patterns, including what makes symptoms better or worse, any triggers for your symptoms, and if symptoms are better or worse at certain times
- What medications you have tried, and how helpful (or unhelpful) you found them
- How easy you find it to take your medications regularly, and whether you use a spacer with inhalers
- History of chest infections, including use of antibiotics and/or steroids, especially over the last year
- History of hospital admissions, especially over the last year
- History of smoking, including e-cigarettes
- Whether you have reflux or sinus problems, and how these are managed
Depending on the information in your referral letter, you may be asked to fill out questionnaires to give us a better idea of your symptoms and the impact they have upon your daily life and wellbeing. Assessments may also include:
- Spirometry: To measure how much air you can breathe out in one breath
- Flow Volume Loop: To support diagnosis of airflow obstruction
- FeNO (Fractional Exhaled Nitric Oxide) test: To look at the level of inflammation in your airways.
- Blood Tests: To check your immune system, and/or signs of infection.
- A nasendoscopy assessment: To assess how healthy your throat is, and to see whether the muscles in your throat are driving any symptoms of cough and/or breathlessness
- Breathing Pattern Disorder (BPD) Assessment: To test how your breathing muscles are working, including how co-ordinated they are, and how much effort is being used to breathe.
- Checking your inhaler technique and peak flow technique: To make sure you understand how to use these correctly
This will depend on the outcome of your assessments and will be made in collaboration with you, and your local team (or the person that referred you). Treatment usually includes:
- Medication review, and possibly changing your medication regime
- Potentially trialling new medications
- Throat care advice
- Breathing exercises
- Lifestyle advice
Follow-up can be arranged to monitor progress with treatment. This can be done as a face-to-face or telephone appointment. It is also possible to refer you back to your local team for follow-up.
It is not always possible to completely resolve asthma symptoms but evidence suggests that personalised treatment can help people to:
- Reduce symptom severity
- Reduce how often you get symptoms
- Improve control of symptoms
Overall improvement will depend on different factors, such as how easy it is for people to:
- Make recommended lifestyle changes
- Take recommended medications, at recommended times
- Practice breathing exercises regularly
- Manage ‘other’ factors that may be contributing to symptoms e.g acid reflux, sinus problems, medication use (e.g. ACE inhibitors)
Right Breathe inhaler usage: https:/
All about asthma: https://
How to use your inhalers: https://
Eating well for healthier lungs: https://
Breathlessness: https://
Adult asthma action plan: https://
Peak flow diary: https://
My asthma inhalers: https://
What to do in an asthma attack: https://
Asthma attack recovery plan: https://
Asthma plan in Arabic: https://
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