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Patient Care

Refractory (Severe) Asthma


What is Refractory Asthma?
Patients are considered refractory when they experience persistent symptoms, frequent asthma attacks or low lung function despite taking asthma medications.  Some refractory asthma patients have to take oral steroids such as prednisone to manage their asthma.

Why do we offer this program?
While patients with refractory asthma are only a small minority of asthmatics, they tend to have significant limits on their ability to lead a high quality life and require a lot of healthcare visits and expenses. We are experienced in the management of poorly controlled asthmatics and develop individualized treatment plans following the latest evidence based guidelines.  Our goal is to treat refractory asthma patients with the least amount of medicine possible while striving to minimize the effect of refractory asthma on people‚Äôs lifestyles. 

We work with other specialties to diagnose and aggressively manage co-morbidities known to complicate refractory asthma control, such as allergies, sleep apnea, acid reflux, vocal cord problems and others.  We provide comprehensive individualized education for refractory asthma and encourage self management skills for the early identification and treatment of asthma attacks reducing the need for emergency room visits or hospitalizations.  We are accessible to providers and patients for ongoing monitoring and management. 

What does the program offer?
We provide a step-wise approach as recommended by the latest guidelines issued by American Thoracic Society.  This begins with a comprehensive history and evaluation of the respiratory system, including:
1. Complete evaluation of lung function.
2. Complete evaluation looking for other conditions known to cause cough, dyspnea, and wheeze and which can also worsen asthma control such as allergies, sleep apnea, acid reflux, vocal cord problems, cystic fibrosis, Churg-Strauss syndrome, allergic bronchopulmonary aspergillosis (ABPA), cardiac disorders and others.
3. Identifying and treating any conditions that result from the need for long-term use of high-dose or strong asthma medications such as prednisone.
4. Individualized treatment plans will be developed that include a holistic approach including education, nutritional guidance, and medical therapy.
5. Treatment of asthma symptoms provoked by exercise.  Exercise is extremely important as it helps to control weight, reduce stress, and increase fitness:  all of which are beneficial in helping to control asthma.  Many asthmatics struggle with asthma symptoms during exercise, but these can be treated to allow you to exercise regularly. 

Follow-up visits are scheduled every 4-6 weeks until symptoms are stabilized; then every 3-4 months for ongoing monitoring and management. 

Your individualized asthma action plan will be reviewed and revised if needed.  Concerns regarding asthma management will be addressed and additional education will be provided.  All test results, progress notes, asthma action plans and education provided will be sent to the primary care provider.  You will be asked to complete an evaluation of the program to help us provide the best care possible.