title: Diagnosis and investigation in the severe asthma clinic.
abstract: Severe asthma is recognised as an important and emerging area of unmet need in asthma. The assessment of severe asthma should include three steps; (1) determining the diagnosis of asthma, including verification that the disease is severe asthma, (2) assessing comorbidities and contributing factors that will impact on clinical severity, as well as (3) assessing asthma phenotypes. These steps recognize the importance of heterogeneity in asthma as a key factor that determines the disease course and increasingly the choice of successful therapy. This assessment should be undertaken systematically and is best done by an expert multidisciplinary team. Here, we will outline the important aspects that should be included in the clinical assessment of the patient in the severe asthma clinic, including diagnosis, clinical history, the assessment of important comorbidities and the key investigations needed to support them.
authors.affiliation: a Centre of Excellence in Severe Asthma , The University of Newcastle , Newcastle , Australia.|b Priority Research Centre for Healthy Lungs , University of Newcastle , Newcastle , Australia.|c Hunter Medical Research Institute , Newcastle , Australia.|d Department of Respiratory and Sleep Medicine , John Hunter Hospital , Newcastle , Australia.
authors.forename: Peter A B
authors.initials: PA
authors.lastname: Wark
authors.affiliation: e Department of Allergy Immunology and Respiratory Medicine , Alfred Hospital , Melbourne , Victoria , Australia.|f School of Public Health and Preventive Medicine , Monash University , Melbourne , Victoria , Australia.
authors.forename: Mark
authors.initials: M
authors.lastname: Hew
authors.affiliation: a Centre of Excellence in Severe Asthma , The University of Newcastle , Newcastle , Australia.|b Priority Research Centre for Healthy Lungs , University of Newcastle , Newcastle , Australia.|c Hunter Medical Research Institute , Newcastle , Australia.
authors.forename: Steven
authors.initials: S
authors.lastname: Maltby
authors.affiliation: a Centre of Excellence in Severe Asthma , The University of Newcastle , Newcastle , Australia.|b Priority Research Centre for Healthy Lungs , University of Newcastle , Newcastle , Australia.|c Hunter Medical Research Institute , Newcastle , Australia.|d Department of Respiratory and Sleep Medicine , John Hunter Hospital , Newcastle , Australia.
authors.forename: Vanessa M
authors.initials: VM
authors.lastname: McDonald
authors.affiliation: a Centre of Excellence in Severe Asthma , The University of Newcastle , Newcastle , Australia.|b Priority Research Centre for Healthy Lungs , University of Newcastle , Newcastle , Australia.|c Hunter Medical Research Institute , Newcastle , Australia.|d Department of Respiratory and Sleep Medicine , John Hunter Hospital , Newcastle , Australia.
authors.forename: Peter G
authors.initials: PG
authors.lastname: Gibson
mesh_terms: D001249:Asthma / Q000175:diagnosis*; D006801:Humans; D010641:Phenotype; D012720:Severity of Illness Index; D063189:Symptom Assessment
keywords: Severe asthma; asthma phenotypes; comorbidities and severe asthma; difficult asthma; multidimensional assessment; severe asthma biomarkers; treatment-refractory asthma