Potential severe asthma hidden in UK primary care

Dermot Ryan, Heath Heatley, Liam G Heaney, David J Jackson, Paul E Pfeffer, John Busby, Andrew Menzies-Gow, Rupert Jones, Trung N Tran, Mona Al-Ahmad, Vibeke Backer, Manon M. Belhassen, Sinthia Bosnic-Anticevich, Arnaud Bourdin, Lakmini Bulathsinhala, Victoria Carter, Isha Chaudhry, Nevaashni Eleangovan, J. Mark FitzGerald, Peter G. GibsonNaeimeh Hosseini, Alan Kaplan, Ruth B Murray, Chin Kook Rhee, Eric Van Ganse, David B Price* (Corresponding Author)

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

43 Citations (Scopus)
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Background: Severe asthma may be under-recognized in primary care.Objective: Identify and quantify patients with potential severe asthma (PSA) in UK primary care, the proportion not referred, and compare primary care PSA patients with confirmed severe asthma patients from UK tertiary care.Methods: Historical cohort study including patients from the Optimum Patient Care Research Database (OPCRD; aged ≥16 years, active asthma diagnosis pre-2014) and UK patients in the International Severe Asthma Registry (UK-ISAR; aged ≥18 years, confirmed severe asthma in tertiarycare). In the OPCRD, PSA was defined as GINA 2018 Step 4 treatment and ≥2 exacerbations/year OR at GINA Step 5. The proportion of these patients and their referral status in the last year was quantified. Demographic and clinical characteristics of groups were compared.Results: Of 207,557 OPCRD patients with asthma, 16,409 (8%) had PSA. Of these, 72% had no referral/specialist review in the past year. Referred PSA patients tended to have greater prevalence of ICS/LABA-add-ons (54.1 vs 39.8%), and experienced significantly (p<0.001) more exacerbations/year (median 3 vs 2/year), worse asthma control and worse lung function (% predicted post-bronchodilator FEV1/FVC 0.69 vs 0.72) versus non-referred patients. Confirmed severe asthmatic patients (i.e. UK161 ISAR) were younger (51 vs 65 years; p<0.001), and significantly (p<0.001) more likely to have uncontrolled asthma (91.4% vs 62.5%), a higher exacerbation rate (4/year [initial assessment] vs 3/year), use ICS/LABA add-ons (67.7% vs 54.1%), and have nasal polyposis (24.2% vs 6.8) than referred PSA patients.Conclusion: Large numbers of patients with PSA in the UK are under-recognized in primary care. These patients would benefit from a more systematic assessment in primary care and possible specialist referral.
Original languageEnglish
Pages (from-to)1612-1623.e9
Number of pages21
JournalThe Journal of Allergy and Clinical Immunology: In Practice
Issue number4
Early online date9 Dec 2020
Publication statusPublished - Apr 2021

Bibliographical note

Funding: ISAR is conducted by Observational & Pragmatic Research Institution (OPRI), and co-funded by OPC Global and AstraZeneca. This research study was co-funded by AstraZeneca and Optimum Patient Care Global Limited, including access to the Optimum Patient Care Research Database (OPCRD).


  • Optimum Patient Care Research Database
  • nternational Severe Asthma Registry
  • potential severe asthma
  • referral
  • tertiary care


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