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Asthma referral checklist

Identification of uncontrolled asthma patients (BTS* step 4 and above)

Patient details Notes:

Inhaler technique good1 Y N


Compliance good1 Y N
Primary concern:
If inhaler technique and compliance are good,
but there are concerns for any of the below,
please consider for referral

Uncertainty regarding
asthma diagnosis2 Y N
>2 courses of oral steroids in Actions required:
last 12 months1 Y N 1.

Admitted to hospital or A&E 2.


with ≥2 asthma incidents
in last 12 months1
Y N 3.

4.
Prescribed >12 short-acting
reliever inhalers in last 12 months1 Y N 5.

Difficult asthma showing persistent Refer to:


symptoms despite optimal therapy
(BTS* step 4)2
Y N GP Consultant

Patients with difficult asthma


and life-threatening attack in
previous 10 years3
Y N Referral letter Y N


This checklist is based on an amalgamation References
of guideline information and is intended for 1. Royal College of Physicians of London, British
Thoracic Society and British Lung Foundation.
use as a reference guide only. A decision to Why asthma still kills: The National Review of Asthma
refer should be based on clinical judgement Deaths (NRAD) Confidential Enquiry Report. London:
Healthcare Quality Improvement Partnership, 2014.
of the patient and their condition.
2. British Thoracic Society Standards of Care
This document is intended for healthcare Committee. BTS statement on criteria for
specialist referral, admission, discharge and
professionals only.
follow-up for adults.
*
British Thoracic Society
3. NHS Commissioning Board. NHS England/A14/S/b.
NHS Standard Contract for Respiratory: Severe
Asthma (Adult). 2013.

RES15-C013 October 2015

118883 Asthma Patient referral checklist_FINAL.indd 1 11/11/2015 11:14


Need more referral checklists?
Contact Novartis Medical Information at medinfo.uk@novartis.com
to request a new tear-off pad of asthma referral checklists.

RES15-C013 October 2015

118883 Asthma Patient referral checklist_FINAL.indd 2 11/11/2015 11:14

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