Why are antibiotics frequently prescribed for asthma?

A new study led by PhD student and Clinical Research Practitioner Mrs Nour Odeh is tackling a persistent question in primary care: why are antibiotics frequently prescribed during asthma exacerbations, despite national guidelines advising against it?

The PAUSE Study – Appropriate Antimicrobial Use for Asthma Exacerbation – is exploring why antibiotics are still commonly used in asthma care, even though most asthma flare-ups are not caused by bacterial infections.

“Asthma is an inflammatory condition, and antibiotics are not typically needed unless there’s clear evidence of a bacterial infection,” Nour explains. “However, in primary care, we don’t have the diagnostic tools to easily confirm if an exacerbation is bacterial or viral. This makes decisions difficult for healthcare professionals.”

National guidelines state that antibiotics should not be prescribed for asthma exacerbations unless there is a clear indication of bacterial infection. But in reality, a lack of definitive tests often leads to uncertainty and, ultimately, to antibiotic prescriptions that may not be necessary.

Laying the Groundwork

The study began with a systematic review of the existing literature on antimicrobial resistance (AMR) and prescribing patterns for respiratory infections. While there was a wealth of evidence on respiratory infections in general, the review revealed a clear gap in understanding when it comes to antibiotic prescribing specifically for people with asthma.

The PAUSE Study

The PAUSE study’s current phase involves qualitative interviews with a broad range of participants:

• Healthcare professionals (including GPs, advanced nurse practitioners, clinical pharmacists)
• People with asthma and parents/carers of children with asthma

The goal is to understand why antibiotics are prescribed so frequently in primary care, and to uncover the underlying pressures, beliefs, and clinical uncertainties involved.

“It’s important to capture as many voices as possible,” says Nour. “Primary care is evolving, with advanced nurse practitioners increasingly managing acute symptoms. That’s why it’s crucial we hear from a wide range of professionals—especially those with prescribing responsibilities.”

A key challenge identified is the lack of diagnostic tools in primary care to confidently distinguish bacterial from viral infections. As one participant noted, the guideline to avoid antibiotics without a “clear indication of bacterial infection” is difficult to follow when that clarity isn’t available.

Patients and parents also contribute valuable insights. Many patients feel they “know their bodies best” and can tell when they need antibiotics, which can be perceived by clinicians as pressure to prescribe. Parents, in particular, expressed a strong sense of advocacy for their children, often pushing harder for antibiotic treatment than they would for themselves.

Next Steps

“Through these conversations, we hope to develop an intervention,” explains Nour. “At this stage, the target audience and the specific behaviour we want to address are still being defined. Once the intervention is developed, we plan to carry out think-aloud interviews to explore how it can be optimised, with the potential to move on to a feasibility study.”

It’s relatively uncommon for a PhD student to lead a research project—but Nour brings a unique dual perspective. With three years of clinical experience and a background in respiratory trials, she continues to work two days a week in a GP setting, helping to bridge the gap between research and real-world practice.