Physiotherapy can have an essential role to play in helping treat children with difficult asthma, and yet there is a lack of consistency in the services available across the UK and insufficient referral to them, according to new research presented at the British Thoracic Society’s Winter Meeting today (Wednesday 6th December 2017).

Approximately 2-5% of children with asthma have ‘difficult asthma’ and can experience high levels of illness - impacting on their quality of life.

Led by Paediatric Research Physiotherapist, Charlotte Wells, from the Royal Brompton Hospital in London, the research involved 18 leading paediatric hospitals across the UK to help benchmark how physiotherapy is currently being utilised, funded and delivered to assist children with difficult asthma.

Charlotte Wells explains:

“Right from the diagnosis of asthma, national guidelines recommend that a specialist multidisciplinary team, including physiotherapy, is involved to exclude alternative causes of persistent symptoms, and then to manage appropriate treatment. Physiotherapy improves asthma symptom scores and quality of life, and yet for many children the referral is simply not made.”

The research findings suggest that current British Thoracic Society guideline recommendations on asthma are not being met:

  • 89% of the hospitals did not have funded ‘difficult asthma’ physiotherapy
  • 66% had no dedicated ‘difficult asthma’ physiotherapy time
  • 94% of centres relied on referrals from ‘difficult asthma’ consultants and nurses rather than having the opportunity to routinely assess ‘difficult asthma’ patients.

Mrs Wells continued:

“Our study revealed there is wide variation across the UK in the physiotherapy service being offered. Everyone is doing different things; from screening tools through to treatments.

It also indicates that many doctors and nurses are not confident in who would benefit from physiotherapy and so do not refer as many children as they could.  This in turn makes it challenging for physiotherapy teams to make a case for additional funding.”

The research concludes that:

  • paediatric physiotherapy for difficult asthma is both ad hoc and reactive
  • more needs to be done to define its role and establish protocols in order that its benefits can be better understood and more suitable children with difficult asthma are identified and referrals made.

Physiotherapy techniques which can benefit children with difficult asthma include: breathing pattern retraining, airway clearance, exercise and fitness, relaxation and anxiety management techniques, chronic cough management, postural exercise and self-management.

The benefits include:

  • Reduced symptoms
  • Reduced admissions to hospital from 8 to 1 and to A&E departments 

(from 47 to 1)[i]

  • Improved quality of life scores
  • Better adherence to medicine

‘Difficult asthma’ in children is defined as asthma that is uncontrolled despite appropriate treatment. Poor control is defined as the need for bronchodilators (inhaled medications that dilate the airway and increase airflow to the lungs) more than three` times a week, school absence of more than five days a term, or one episode or more of wheezing each month.


For more information prior to the British Thoracic Society Winter Meeting (that is, before Wednesday 6thDecember 2017), please contact:

Rosie Strachan: t: 020 7831 8778 or 07566 223644

Charlotte Sutton: t: 07958 279240

Ed Gyde t: 020 7831 8778 or 07809 574801   

During the British Thoracic Society meeting (from Wednesday 6th to Friday 8th December 2017):

Please contact the BTS news media office on t: 020 7798 4801/ 020 7798 4541 or the mobile numbers above.

Note to Editors:
The British Thoracic Society is the UK’s professional body of respiratory specialists. The Society seeks to improve standards of care for people who have respiratory diseases and to support and develop those who provide that care.  A registered charity, it has over 3,400 members including doctors, nurses, respiratory physiotherapists, scientists and other professionals with a respiratory interest. For more information, go to


The British Thoracic Society Winter Meeting takes place from Wednesday 6th to Friday 8th December 2017 at the Queen Elizabeth II Conference Centre in Westminster, London.



[i] Reference: Lilley A, Turner L.  Assessing the benefits of having a specialist pediatric pharmacist and physiotherapist in the community to improve childhood asthma outcomes. Arch Dis Child 2016 Sept; 101 (9)