Abstract
The United Kingdom National Review of Asthma Deaths (NRAD) recommends that patients who require ≥3 courses of oral corticosteroids (OCS) for exacerbations in the past year or those on British Thoracic Society (BTS) Step 4/5 treatment must be referred to a specialist asthma service. The aim of the study was to identify the proportion of asthma patients in primary care that fulfil NRAD criteria for specialist referral and factors associated with frequent exacerbations. A total of 2639 adult asthma patients from 10 primary care practices in Glasgow, UK were retrospectively studied between 2014 and 2015. Frequent exacerbators and short-acting β2-agonist (SABA) over-users were identified if they received ≥2 confirmed OCS courses for asthma and ≥13 SABA inhalers in the past year, respectively. Community dispensing data were used to assess treatment adherence defined as taking ≥75% of prescribed inhaled corticosteroid (ICS) dose. The study population included 185 (7%) frequent exacerbators, 137 (5%) SABA over-users, and 319 (12%) patients on BTS Step 4/5 treatment. Among frequent exacerbators, 41% required BTS Step 4/5 treatment, 46% had suboptimal ICS adherence, 42% had not attended an asthma review in the past year and 42% had no previous input from a specialist asthma service. Older age, female gender, BTS Step 4/5, SABA over-use and co-existing COPD diagnosis increased the risk of frequent exacerbations independently. Fourteen per 100 asthma patients would fulfil the NRAD criteria for specialist referral. Better collaboration between primary and secondary care asthma services is needed to improve chronic asthma care.
Highlights
Asthma is the most prevalent chronic respiratory disease in the world affecting an estimated 358 million people in 2015.1 The prevalence of asthma is high in the United Kingdom compared to many other countries,[2] ranging from 29.5% (18.5 million people) for lifetime symptoms suggestive of asthma to 5.7% (3.6 million people) for those with active, clinician-diagnosed-and-treated asthma.[3]
A total of 48,462 patients were registered with the ten participating primary care practices
A total of 2639 (5%) patients received at proportion of them were on British Thoracic Society (BTS) Step 4/5 treatment (22% vs 12%, p < 0.001) and were frequent exacerbators (18% vs 6%, p < 0.001)
Summary
Asthma is the most prevalent chronic respiratory disease in the world affecting an estimated 358 million people in 2015.1 The prevalence of asthma is high in the United Kingdom compared to many other countries,[2] ranging from 29.5% (18.5 million people) for lifetime symptoms suggestive of asthma to 5.7% (3.6 million people) for those with active, clinician-diagnosed-and-treated asthma.[3]. There were 1370 asthma deaths across the United Kingdom in. 2016, among them 133 in Scotland (data from National Records of Scotland) and 1237 in England and Wales (data collected from Office for National Statistics in England and Wales). It is over 40 years since the first studies on asthma deaths in the United Kingdom were published in the 1970s.5–7. 2.7 million GP consultations, 3.7 million nurse consultations and 54,000 out-of-hours calls for asthma in 2011–2012.3 The annual costs of asthma are estimated to be at least £1.1 billion with the majority incurred in primary care and ~10% in secondary care.
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