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:

• The National Bundle of Care resource pack (pages 14-23) includes national standards of care for difficult to treat/severe asthma services.
• The Severe asthma service referral pathway for CYP in London developed by the Severe Asthma Group, a subgroup of the London Asthma Leadership and Implementation Group (LALIG), shows the route to a specialist (tertiary) severe asthma service for children aged 5 – 16 years with problematic asthma. Referrals can be made from primary or secondary care
• NHS England’s National Bundle of Care for children and young people with asthma sets out a series of standards to help integrated care systems (ICSs) improve health outcomes for all children and young people with asthma. There is a section on severe asthma with national standards of care covering how severe asthma services should be delivered across an area.
• 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.