A difficult asthma assessment can help us understand more about your child's asthma. There can be lots of reasons why they may be finding it hard to control. We will work with you and your child to identify what could be causing it and what treatment should help. Often we can suggest simple things to improve your child's asthma without increasing their dose of medication.

The assessment

Before the assessment

Your child should take their normal inhalers on the morning of the assessment, except for the blur inhaler (subutamol). They will need to not take it for at least four hours before the appointment. But if they need it, let them take it and note down the time so you can tell us when you arrive for the appointment. You should also bring all your child's medications with you. If they take antihistamine (allergy) medication, they will need to stop taking this for 48 hours beforehand unless they need to.

When you arrive, you will meet with one of our respiratory clinical nurse specialists (CNS). They will ask you and your child a series of questions to find out information such as how often they have asthma attacks. The CNS will review your child's medications and their inhaler technique. You and your child will both fill in questionnaires about how asthma affects their daily life and mood.

The CNS will give you a Smartinhaler (a device that attaches to a steroid inhaler) to use for the next two months. This checks how often your child uses their steroid inhaler in this time. It is important to look after this device and return it on your next visit.

There is also a series of tests during the appointment:

  • Spirometry - this checks how well they are breathing. We will get them to breathe in fully and then blow out as hard and as fast as they can into the mouthpiece of the spirometer.

  • Skin prick testing (allergy testing) - this is a safe way to test for allergies to common substances such as grass pollen and house dust mites. The tests are not painful, but they may have an itchy rash for about 30 minutes afterwards.

  • Urine test - their urine sample will show us if they have been exposed to environmental tobacco smoke.

  • Exhaled nitric oxide - this test measures how much swelling there is in the airways. They will need to breathe in and out of a mouthpiece, attached to a special machine.

  • Blood tests - this is to check their general health

  • Adrenal gland function tests - this checks if their adrenal glands are working properly.

We may arrange for the blood and adrenal gland tests for a different date, but we will let you know. If your child has had some of these tests done recently, they may not need them repeated.

Home visit

After your visit to the clinic, the same CNS will also do the home visit. This is another opportunity for them to understand more about your child's asthma. Your child does not need to be home for the visit, so if it is during term-time, they can go to school as normal.

During the visit, the CNS will have a look around your house to see if there are any possible triggers and give advice on how best to tackle them. There is no need to make any special preparations for the visit as the CNS will need to see your home on a normal day.

Your CNS will also arrange a visit to your child's school. You can find out more information about this by clicking on the 'Information' tab.

The Trust’s paediatric difficult asthma service has an international reputation for the assessment and management of children with difficult to control asthma. 

School visit

when your CNS visits your child's school, they will go through a few topics with them, including:

  • attendance

  • asthma symptoms

  • if they can take part in physical education (PE0 lessons

  • the school's asthma action plan

These will help them complete the assessment. They will be able to offer support to the school in managing your child's asthma and can offer asthma care training or to attend any meetings.

After the assessment

Once the assessment is complete, all the healthcare professionals involved in your child's care will meet to discuss the results. They will make recommendations about how to manage your child's asthma. These will then be shared with you at the next hospital appointment, and we will send a summary to your GP and the local hospital. You will also get a copy of this.

Most of the time we find ways to improve your child's asthma without increasing their medication or having more assessments. But if your child needs more assessments, we will discuss this with you.

We may ask a physiotherapist to assess your child's breathing during or after the initial assessment. They can give advice about helpful breathing control exercises that could help ease asthma symptoms, especially during an attack. We may also refer your child to see a specialist asthma psychologist if we think anxiety and stress could be affecting it. They can help your child manage their asthma and cope with the emotional impact of having the condition.

Meet the team

Paediatric respiratory consultants:

Dr Louise Fleming 
Dr 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 (PDF, 2MB)