A diagnostic approach to ‘difficult’ asthma

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Some patients' wheezing and labored breathing are not controlled with the usual therapies for asthma. The authors call this problem “difficult” asthma and outline an approach to evaluation: First, disorders that mimic asthma must be excluded. Then, once asthma is diagnosed, a search for triggers, exacerbating conditions, sensitivities to hidden ingredients in foods and drugs, and lack of attention to medication regimens can begin. Many possible contributing factors are addressed.