Potential Severe Asthma Hidden in UK Primary Care.

Area of Science:

• Respiratory Medicine
• Primary Care Medicine
• Clinical Epidemiology

Background:

• Severe asthma is often underdiagnosed in primary care settings.
• Identifying patients with potential severe asthma (PSA) is crucial for timely intervention.

Purpose of the Study:

• To identify and quantify patients with PSA in UK primary care.
• To determine the proportion of PSA patients not referred to specialists.
• To compare characteristics of PSA patients in primary care with confirmed severe asthma patients in tertiary care.

Main Methods:

• Historical cohort study using the Optimum Patient Care Research Database (OPCRD) and the International Severe Asthma Registry (UK-ISAR).
• PSA defined by Global Initiative for Asthma (GINA) 2018 guidelines (step 4/5 treatment, ≥2 exacerbations/year).
• Quantified referral status and compared demographic/clinical characteristics between groups.

Main Results:

• 8% of 207,557 asthma patients in OPCRD had PSA; 72% were not referred.
• Referred PSA patients had more exacerbations, worse control, and poorer lung function than non-referred.
• Confirmed severe asthma patients were younger, more likely to have uncontrolled asthma, and had higher exacerbation rates than referred PSA patients.

Conclusions:

• A significant number of patients with PSA in the UK remain underrecognized in primary care.
• These patients require systematic assessment and potential specialist referral for optimal management.
• Improved primary care pathways are needed to ensure timely identification and treatment of severe asthma.