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Insights into frequent asthma exacerbations from a primary care perspective and the implications of UK National Review of Asthma Deaths recommendations

Jieqiong Freda Yang, Rekha Chaudhuri, Neil C Thomson, et al.
npj Prim Care Respir Med 2018;28:35
doi: 10.1038/s41533-018-0103-9

The UK has the third highest death rate for asthma of high-income countries worldwide, and this carries annual costs of at least £1.1 billion, primarily in primary care. Despite new asthma treatments and various evidence-based management guidelines, morbidity and mortality rates continue to climb.

The key findings of the 2014 National Review of Asthma Deaths report Why asthma still kills were that overall asthma management in primary and secondary care was considered good in less than 20% of people who died, and that potentially avoidable factors were identified in two-thirds of cases. Its 19 recommendations included that patients must be referred to a specialist asthma service if they had required three or more courses of systemic corticosteroids on one or more hospital admissions in the previous 12 months, or British Thoracic Society (BTS) Step 4/5 treatment, to achieve control.

Yang and colleagues conducted an observational study of asthma patients from 10 primary care practices in the North Greater Glasgow area over a 12-month period between 2014 and 2015, with two aims: (1) to identify asthma patients with recurrent exacerbations or on a high level of treatment who would merit referral, and (2) to study the biopsychosocial factors associated with frequent exacerbations.

They concluded that primary and secondary specialist asthma services need to work more closely to prevent asthma deaths, by employing a structured approach to managing patients in primary care and referring those with diagnostic uncertainty or therapy-resistant asthma to a specialist asthma service.

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