This section is intended for clinicians caring for children with asthma in a hospital or tertiary care setting. It outlines examples of best practice in the assessment, treatment and ongoing management of children and young people with asthma in an acute setting.

There are a number of children who have persistent symptoms or frequent exacerbations (or both) despite optimal management in secondary care.

Children with problematic severe asthma should be referred to a specialist difficult asthma team in tertiary care. The criteria for which children MUST be referred to a tertiary service are set out in the following:

• Referral pathway for severe asthma, developed by the London Severe Asthma Group.
• The National Bundle of Care resource pack (pages 14-23) includes national standards of care for difficult to treat/severe asthma services.
• The Health Innovation network in Oxford and Thames Valley have produced a set of patient information leaflets which support early identification, informed conversations and helping patients to get the most from their asthma medication. Patient information – Health Innovation Oxford & Thames Valley.