A clinical algorithm for distinguishing between uncontrolled asthma and severe refractory asthma. Specialist
protocols for identifying severe refractory asthma often start with confirmation of the diagnosis of asthma
. The GINA report takes a more pragmatic approach, with the algorithm starting with the most
common causes of uncontrolled asthma, namely incorrect inhaler technique (up to 80% of patients)
and poor adherence (at least 50% of patients) [36]. This is an efficient approach, as these problems are
often readily identifiable, can be corrected in primary care , and, if improved inhaler technique and
adherence lead to substantial improvements in symptoms and lung function, may avoid the need for
additional investigations or specialist referral to confirm the diagnosis of asthma.