Severe Asthma
NHS Tayside RefGuide
Who to refer
Any patient receiving maintenance oral corticosteroids for asthma (> 3 weeks course)
Or ≥3 exacerbations in previous 12 months
Make an urgent referral for any patient on moderate dose MART with >/= 3 exacerbations with EoS >3 or FeNO > 30
Who not to refer
Patients who do not have severe asthma as per the criteria set out
How to refer
SCI Gateway/Respiratory/Airways Disease
Alternative to Referral
Advice available through SCI-Gateway as above
Condition Description
Severe persistent asthma characterised by frequent symptoms despite high-dose inhaled corticosteroids and additional controller therapy. The patient experiences recurrent exacerbations requiring oral corticosteroids, has reduced lung function (FEV₁ <80% predicted), and significant impact on daily activities. Ongoing symptoms include wheezing, breathlessness, and nocturnal cough. Triggered by allergens, viral infections, and environmental irritants.
Primary Care Investigation
Management is as per nhs-scotland-severe-asthma-pathway-february-2026.pdf
As per flow chart:
Identify patients at risk of severe asthma
Optimise current therapy for the patient
Assess for reversible factors
Primary Care Management
Management is as per nhs-scotland-severe-asthma-pathway-february-2026.pdf
As per flow chart:
Maintain therapy
Schedule asthma (face to face) review