Difficult-to-manage asthma - How to pinpoint the exacerbating factors

Asthma can be difficult to manage in some patients, and the reason may not be readily apparent to either physician or patient. When even aggressive tr eatment fails to control asthma symptoms, where do you begin to look for th e possible cause or causes? This article provides a brief overview of the p athogenesis of asthma and a discussion of exacerbating factors to consider in evaluation of difficult-to-manage cases. A handy algorithm showing a ste pwise approach to evaluation is included.