We are known around the world for the standard of care and management we give to children with difficult to control asthma. We receive referrals from around the UK because of the high standard our multidisciplinary team offer.

What is difficult asthma?

Asthma is a common lung condition which causes breathing difficulties. Most children with asthma have good control of their symptoms with low doses of asthma medications. But, for some children, this is not the case. Some children continue having symptoms that could cause asthma attacks even with increasing their medications.

Difficult asthma assessment

Our paediatric difficult asthma team includes:

  • specialist children's asthma nurses
  • doctors
  • psychologists
  • physiotherapists.

They will carry out a detailed assessment to try and find out as much as possible about why your child’s asthma is difficult to control.

There can be lots of different reasons why their asthma is not being controlled properly. So we work with the child and their family, the local hospital, GP and school to identify possible causes and suggest the best treatment.

Severe asthma

For most children, once they have had their initial assessment, their symptoms improve. But for some children, they still have poor asthma control despite high levels of treatment. We have an approach where we use bronchoscopy to understand more about the type of asthma the child has and what will be the best treatment for them.

Younger children

Many pre-school age children can have severe wheezing episodes and trouble breathing, which could be difficult to diagnose asthma.

We will adapt how we assess this for younger children to establish the cause of the symptoms and then decide the best treatment.

Breathlessness during exercise

For some children, they find that they are breathless during exercise or other activities, like playing an instrument. We have a specialist service for children who suffer with trouble breathing in these situations.

We may have to carry out further tests, such as a cardiopulmonary exercise test (CPET), a histamine challenge (provocation test) or continuous laryngoscopy during exercise (CLE). The physiotherapy team have specialist expertise in this area, so will be able to answer any questions you may have.

Difficult asthma assessment

This assessment looks at the many possible reasons why a child's asthma may be difficult to control and identifies possible causes so that we can suggest the best treatment for the child. 


A bronchoscopy is a procedure where a doctor can look at the trachea (windpipe), the bronchi (branches of the airways) and into some areas of the lungs.

Cardiopulmonary exercise test

A cardiopulmonary exercise test (CPET) lets your doctor see how your lungs, heart and muscles react together when you exercise. 

Outpatient appointments

We run our outpatient clinics on the mezzanine floor of Fulham Wing. Most appointments are on a Tuesday morning, but for children with difficult asthma, we also have appointments on a Wednesday afternoon and Friday morning.

At the first appointment, you will meet with one of our doctors and one of the specialist asthma nurses. We will ask lots of questions about the child's asthma and also carry out some tests. You will also meet with a physiotherapist and psychologist from the team in your first appointment.

The assessment normally takes about half a day to complete, so will be a full morning or afternoon. We may need to arrange another time to complete the assessment if there isn't enough time.

If you cannot make the appointment, contact the children's respiratory nursing team so we can offer the appointment to someone else. You can find the contact details on your appointment letter.

Home visits

The team may find it helpful to visit the child at home to find out more about their asthma. We will discuss this with you in the appointment and organise a time to visit.


A physiotherapist may assess a child's breathing pattern during the appointment. They will be able to give advice about breathing control exercises to help with breathlessness. These exercises can help ease asthma symptoms, especially during an attack. Find out more about breathlessness during exercise.


For some children, stress and anxiety can affect a child's asthma. If this is the case, we may refer them to a specialist asthma psychologist. You may meet with one during the initial assessment to help identify if a child would benefit from this.

Admission to hospital

It can be helpful to find out more about a child’s asthma during a planned admission. This gives us the opportunity to closely observe and assess their asthma over a longer time. It usually lasts for two weeks.

We tailor the admission to the child and will talk through the plan with them and their family.


Once a child is about 14 years old, we will start talking with them about the transition into adulthood. We will look at helping them to understand asthma and its treatments. We will also look at lifestyle subjects such as diet, exercise and smoking. If they would like to be on their own during the consultation, they will be offered this as well.

We will also discuss the options for ongoing care. Some young people will have their follow-up with their GP and some with their local hospital. For others, they will be transferred to our adults' services. This decision is normally made with they are around 16-17 years old and made together with them and their family.

We have a dedicated adolescent clinic where we see teenagers with asthma and other respiratory conditions. For those transferring to our adult asthma service, they will be able to meet with the team in the adolescent clinic at least once before they are transferred.

Meet the team

Paediatric respiratory consultants

Dr Louise Fleming 
Professor Sejal Saglani
Professor Andrew Bush
Dr Ian Balfour-Lynn

Specialist children’s asthma nurses

Pippa Hall (lead children’s nurse specialist)
Angela Jamalzadeh
Rachael Moore-Crouch
Yvie Bingham (research nurse)


Dr Georgie Housley
Charlotte Wells


Dr Fran Beresford


Sukeshi Makhecha

Useful information

This leaflet gives more information:

Your child's difficult asthma assessment - June 2016 (PDF, 2.5MB)

These websites also contain more useful information on asthma.