Paediatric difficult asthma service

The paediatric difficult asthma team has a national and international reputation in the assessment and management of children with difficult to control asthma and severe pre-school wheeze.  

We focus on accurate diagnosis, identification and correction of potentially modifiable factors and assessment of airway phenotypes so that we can personalise management for every child referred to us. We achieve this through clinical excellence and a cutting-edge research programme.

Referrals for school-aged asthma and pre-school wheeze 

We accept referrals from primary and secondary care as well as from other tertiary care centres. Referral guidelines can be found in the forms below, however, it should be stressed these are a guide and we are happy to accept referrals for any child whose respiratory symptoms give cause for concern.

Referral to difficult asthma service (PDF, 103KB)

Pre-school wheeze referral form (PDF, 131 KB)

Exercise-induced breathlessness

We offer a specialist service for children and young athletes who are particularly troubled by breathlessness during exercise or in response to other activities.  Investigations that we can carry out if indicated include cardiopulmonary exercise test (CPET), methacoline challenge (bronchial provocation test), eucapnic voluntary hyperventilation test (EVH) and continuous laryngoscopy during exercise (CLE). Our physiotherapy team have specialist expertise in this area. The physiotherapist will perform a breathing assessment and give expert advice on how to help improve breathing with exercise. 

At present, the physiotherapy department is unable to accept direct referrals. If you feel a child would benefit from specialist physiotherapy input please refer to one of the paediatric respiratory consultants.

Physiotherapy in the management of children and teenagers with asthma

We have created some learning resources, including a series of videos featuring exercises and interactive demonstrations that children and teenagers can use to help them learn about breathing patterns and breath training, techniques to help control asthma symptoms, and how exercise and physical activity can boost lung health and overall wellbeing.

Shared care

For children referred from, or already under the care of, a secondary care centre, we offer shared care including joint multi-disciplinary team meetings.


There is a significant need to improve our understanding of the causes of asthma and pre-school wheeze, identify different types of asthma and reduce the risk of asthma attacks and asthma deaths. In order to achieve this, we have an active and innovative research programme. Almost all children referred to our service are offered the opportunity to enrol in at least one of our on-going studies. In addition to our own studies, we are involved in a number of national and international collaborations and commercial trials.

Paediatric respiratory consultants

Dr Samatha Sonnappa 

Dr Louise Fleming

Professor Sejal Saglani

Professor Andrew Bush

Dr Ian Balfour-Lynn