Focused history and examination of a young person with difficult asthma
| History or examination domain | Questions to elucidate asthma severity, phenotype and comorbidities |
| Age and mode of onset | Age of symptoms and asthma onset, any relation to puberty |
| Symptoms pattern | Dyspnoea pattern (episodic versus constant), presence and phase of wheeze (inspiratory/expiratory), cough, sputum production and colour, propensity for LRTI |
| Allergies and triggers | Rhinitis, hay fever, atopic dermatitis, food and aeroallergies, nonspecific triggers (e.g. strong smells, changing temperature), aspirin intolerance, perimenstrual exacerbation |
| Asthma control and severity measures | Frequency of OCS and antibiotic use, SABA use (inhaled or nebulised), emergency room visits, hospitalisation, high dependency and intensive care unit admission, and intubation history |
| Upper airways symptoms | History of rhinitis, polyps, blocked nose, post-nasal drip, and any features of ILO (e.g. throat level symptoms, sensation of strangulation, breathing through a straw, or difficulty to breathe in) |
| Breathing pattern disorder | Features of hyperventilation syndrome such as air hunger, perioral and extremities paraesthesia during attacks, constant dyspnoea, disproportionate level of exercise limitation |
| Past medical history | Obesity, sleep apnoea, metabolic syndrome, cardiac disease, congenital anomalies, etc. |
| Psychological factors | Childhood traumatic experience, schooling difficulties, panic, anxiety, depression, personality traits, home and family factors |
| Personal and social history | Home, number of people at home, indoor pollution (pets, moulds, dust), outdoor pollution, smoking (passive/active), alcohol and illicit drug use |
| School and occupational history | Schooling and sport performance and attendance, triggers at school or work |
| Physical examination | Height, weight, BMI, nose and throat assessment, breath sounds, presence of wheeze (polyphonic and variable versus monophonic and fixed), breathing pattern such as apical breathing, stigmata of other diseases including skin and any OCS-related side-effects |
LRTI: lower respiratory tract infection; SABA: short acting β2-agonist; OCS: oral corticosteroids; BMI: body mass index; ILO: inducible laryngeal obstruction.