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Conditions and treatments

Adult asthma

You have been referred to Royal Brompton Hospital for investigation into your severe or difficult-to-treat asthma.  


Many of the patients who are referred to our asthma clinic have symptoms that have been severe or difficult to explain or control (refractory).

Therefore, we sometimes ask patients to stay with us for a few days to carry out a detailed assessment to try and understand exactly what is causing their symptoms, and how best to treat them.

What is severe or difficult-to-treat asthma?

Asthma is a common lung condition that causes occasional breathing difficulties. There is no cure for asthma but in most sufferers, available treatments keep their symptoms under control. However around 17 per cent of people with asthma suffer from either difficult-to-treat or severe asthma.

Difficult-to-treat asthma

People with difficult-to-treat asthma may have difficulty breathing, which normal asthma treatments are not able to control. They may also have very severe asthma attacks.

Severe asthma

People with severe asthma find that their asthma cannot be treated with normal asthma treatments and that other causes and triggers for their asthma, such as smoking and other long-term conditions, have been ruled out.

Admission to the hospital

During your time in hospital you will stay on Lind ward, which is in the Fulham Road wing of Royal Brompton Hospital.

What you should bring

During your stay you can wear your normal everyday clothes. You will need to bring:

  • loose, lightweight clothes
  • comfortable shoes eg trainers, in case you need to have an exercise test
  • toiletries (the hospital provides towels)
  • nightwear (pyjamas/nightdress, slippers, dressing gown)
  • all your current medication in its original containers and, if possible, an up-to-date list of your prescription medication
  • books, magazines, laptops, mobile phone and chargers, if necessary.

Wifi internet is provided free of charge.

Please note that you are responsible for the safekeeping of your possessions and the hospital can’t accept liability for the loss or damage of any items during your admission.

Is there any medication I should avoid taking before my admission?

Please try and avoid taking the medications listed below because they can affect the test results or make them difficult to understand:

  • inhalers – please do not use on the day of admission unless absolutely necessary (see below), for example:        
    • Symbicort
    • Seretide
    • Flutiform
    • Fostair
    • Qvar       
    • Oxis
    • Relvar
    • Spiriva
  • theophylline tablets – please do not take on the evening before your admission or the morning of your admission, for example:   
    • Phyllocontin
    • Uniphyllin
    • Slophyllin
  • antihistamines – please do not take for three days before admission, for example:
    • oloratidine (Clarityn)
    • odesloratidine (Neoclarityn)
    • ofexofenadine (Telfast)
    • ochlorphenaramine (Piriton).

If you find it difficult to manage without your inhaler, please only use your bronchodilator (Ventolin, salbutamol, Bricanyl). When you arrive for your tests, please tell us if you have used it and at what time.

You can continue to take all your other medication as usual and it is important that you keep taking prednisolone (steroid tablets), if it is a regular medication for you.


You will have a number of different tests during your stay at the hospital. We look at any previous tests that you have had at other hospitals and only repeat them if necessary. You may have some of the tests below, but not everyone will need to have all of them.

Lung function tests

Lung function tests (including measurement of spirometry, lung volumes and gas transfer) are ‘breathing’ tests, which look at how well your lungs work. Sometimes we ask you to use a salbutamol inhaler during the test, which we will give you. The tests usually take around an hour.

Histamine challenge (provocation) test

Some patients will have another breathing test – a histamine challenge. This test helps us to understand whether your symptoms are due to asthma. Using a nebuliser, you will be asked to inhale small, gradually increasing doses of a histamine solution to see how it affects your lung function.


Skin prick tests (allergy testing)

This is a safe way of testing for allergies to common substances, for example grass pollen and house dust mites. It is not painful, but can cause an itchy rash that lasts up to 30 minutes.

Echocardiogram (echo)

This is a heart scan to look at the structure and function of the heart (similar to the ultrasound scan carried out on pregnant women). Some gel is placed on your chest and an ultrasound probe is moved over your chest. It can tell us whether your symptoms may be partly caused by your heart, or if there are any signs of side effects on your heart due to your asthma.


CT scan

This is a scan of your lungs and chest. It gives us more detail than a chest X-ray. The pictures can help understand more about what might be causing your symptoms.

Sleep study

You may have an overnight sleep study, which provides information about how much your oxygen levels vary while you are asleep. Changes in oxygen levels overnight can be due to a condition called obstructive sleep apnoea or may occur as a result of lung disease. This test involves wearing heart rate and oxygen level monitors while you are asleep.

DEXA scan/bone densitometry scan

A DEXA scan is a special type of X-ray that measures bone minderal density. DEXA scans are often used to diagnose or assess someone's risk of osteoporosis, a condition that weakens bones and makes them more likely to break. A DEXA scan is more effective than normal X-rays in identifying low bone mineral density; it is quick and painless.

Blood tests

You will have some blood tests, to check, for example, the function of your immune system, and if your medications are being absorbed properly. We have patient information leaflets with more details about lung function tests, echocardiograms and CT scans.

When will I get my test results?


Your test results and any changes to your treatment will be explained to you by one of the doctors before you go home. After you go home you may need some extra tests. If they are needed we will discuss this with you.

Who will I see during my stay?


Asthma specialist nurse

You will see the asthma specialist nurse, who will have a detailed discussion with you about your symptoms and about your treatment.

Ear, nose and throat (ENT) review

People often have some inflammation in their nose without noticing any symptoms. Treating this inflammation can help improve asthma symptoms, so most patients will see a nose specialist during their assessment.

Physiotherapy review

All patients see a physiotherapist. Physiotherapists can help with a variety of problems, including:

  • breathlessness
  • issues with physical activity and exercise
  • difficulty with clearance of sputum (mucus, phlegm).

Speech and language therapist

If we feel that your upper airways (throat) may be contributing to your symptoms, you may see the speech and language therapist who specialises in voice and throat symptoms.

Psychology review

Patients have the opportunity to speak to our psychologist during their admission. It is important to address the psychological wellbeing of anyone who has chronic respiratory symptoms.

At the end of your stay

At the end of your stay, the consultant will create a management plan for your asthma and will arrange any necessary follow-up appointments.

You will normally be followed up as an outpatient, although a further inpatient stay can be arranged if necessary. 


Meet the team



Dr Andrew Menzies-Gow

Professor Paul Cullinan

Dr James Hull

Dr Alexandra Nanzer-Kelly

Dr Jo Szram

Dr Johanna Feary 

Specialist nurses


Suzie Regan

Rachel Stead

Donna Ell


Clinical psychology service


Dr Anne-Marie Doyle

Dr Jo Ashcroft




Lizzie Grillo

Sarah Todd

Sarah Akers


Speech and language therapist


Dr Julia Selby



If you have any other questions or if you need to change or cancel the admission, please contact:


Kelly Fairclough
Bed coordinator
Telephone: 020 7351 8092 (direct line)
Switchboard: 020 7352 8121, and ask for bleep 7703
Email: k.fairclough@rbht.nhs.uk

Read more about


Featured in the press

Dr James Hull, consultant respiratory physician, spoke to Cyclist magazine in response to reports around athletes using nebulised bronchdilator therapy. 

Read the full article

With thanks to Cyclist magazine.