Abstract
BackgroundAsthma, a common yet complex airway disorder affecting about 11% of Australians, is well-controlled in only 54% of people with asthma. Those with difficult-to-treat and severe asthma are more likely to experience recurrent and potentially life-threatening exacerbations. It is therefore important that GPs can initiate a systematic approach for the management of patients with difficult-to-treat asthma to identify those whose condition may improve by addressing contributory factors and those who require specialist input. We therefore aimed to develop and deliver an educational program for GPs on the systematic management of patients with difficult-to-treat and severe asthma and evaluate the effectiveness of this program.MethodsWe developed an educational program on the management of difficult-to-treat and severe asthma in primary care that was delivered to GPs and other health professionals between January and June 2018. We evaluated the effectiveness of the program using a retrospective pre-test with post-survey, administered to GPs directly after program participation.ResultsOver 1000 general practice health professionals participated in the educational program, including 890 GPs of whom 226 (25%) completed the survey. Following program participation, a greater proportion of GPs identified factors they would assess in managing a patient with poor asthma control, particularly for considering the risk of future adverse outcomes (+ 51%), changes in lifestyle (+ 38%), and self-management strategies (+ 35%). GPs indicated a greater awareness of the biologic therapies that specialists could consider prescribing to their patients with severe asthma (+ 75%), of the requirements for a patient to be prescribed a biologic therapy (+ 73%) and that patients with different phenotypic characteristics can respond differently to standard therapy (+ 67%). The proportion of GPs who would refer appropriate patients to a specialist also significantly increased.ConclusionsThis study suggests that an evidence-based educational program can improve GP knowledge, confidence and intended practice in managing patients with difficult-to-treat and severe asthma.
Highlights
Asthma, a common yet complex airway disorder affecting about 11% of Australians, is well-controlled in only 54% of people with asthma
General practitioner (GP) could select more than one asthma definition per statement though most GPs appropriately identified uncontrolled asthma (76%, n = 168) and difficult-to-treat asthma (69%, n = 154)
43% of GPs selected severe asthma for statement 2 which is most appropriately described as difficult-to-treat asthma
Summary
A common yet complex airway disorder affecting about 11% of Australians, is well-controlled in only 54% of people with asthma Those with difficult-to-treat and severe asthma are more likely to experience recurrent and potentially life-threatening exacerbations. Most people’s asthma can be effectively treated by general practitioners (GPs) with available medicines, a significant population has uncontrolled asthma despite high-dose treatment. These patients are categorised as having difficult-to-treat asthma [4]. Poor asthma control in these patients is most commonly due to factors other than asthma itself — including poor adherence to treatment or incorrect inhaler technique [5] This is not the case for those with true severe asthma, whose asthma remains uncontrolled or fails to improve despite treatment optimisation, confirmation of the diagnosis and treatment of confounders [6]. Patients with severe asthma, who make up 3 to 10% of the population of adults with asthma, are at increased risk for medication-related side-effects, and are more likely to experience recurrent and potentially life-threatening exacerbations [7]
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