Severe Asthma: Symptoms

• Severe asthma patients should be managed under tertiary/specialized care. Would there be a significant population of patients with potential severe asthma (PSA) under primary care that are not recognized? 

• PSA is defined as:

  • asthma patients on long-term control medications and 2 or more exacerbations or 

  • patients on high-dose, long-term control medications..

Additional hypotheses:

• Would the severity of symptoms and diseases in primary care patients with PSA be similar to patients with confirmed severe asthma? 

• Would some symptoms and diseases related to severe asthma be effective in assisting physicians to identify PSA patients within primary care? 

• Would patients with greater prevalence of inhaled corticosteroid/more exacerbations/worse asthma control be more likely to have PSA? 

• This new knowledge contributes to the development of a new hidden severe asthma identification tool which is based on automated algorithms and can be evaluated in a prospective trial (phase 2), which could include assessment of improvements in referrals and deaths. 

• A new hidden severe asthma identification tool has been developed to identify patients in family medicine clinics whose phenotype matches a severe asthma patient. The tool aims to encourage referral and treatment protocols for identified patients. 

• Differences in definition and diagnostic practices of severe asthma around the world may have caused an underestimation of the true size of the severe asthma population. 

• Function of how asthma is managed nationally could have also contributed to the underestimation of the true size of the severe asthma population. 

• Primary care physicians are often reluctant to refer patients with asthma to specialist care, as they work under the expectation that all asthma can be managed effectively in primary care and/or are unaware of the benefits of referral.

• Prior research has reported that 19% of deaths attributable to asthma were associated with potentially avoidable factors related to access to specialist care, such as failure to refer or delayed referral. It was hypothesized that these patients with PSA should be identifiable within existing medical records and new methodologies could be developed and tested. 

• OPRI performed an SIE study to characterize confirmed patients with severe asthma as compared to patients with suspected severe asthma who had not been referred to specialists. These were found: 

  • to be younger (51 vs 65 years),

  • to have significantly worse asthma control (91.4% vs 62.5%),

  • to have a higher AER (4 vs 3),

  • to have a higher usage of inhaled corticosteroid (67.7% vs 54.1%)

  • to more likely to have nasal polyposis (24.2% vs 6.8%)