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

Yang, J. F. et al. (2018) Insights into frequent asthma exacerbations from a primary care perspective and the implications of UK National Review of Asthma Deaths recommendations. npj Primary Care Respiratory Medicine, 28, 35. (doi: 10.1038/s41533-018-0103-9) (PMID:30232329) (PMCID:PMC6145932)

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.

• Item Type: Articles
• Additional Information: This audit was funded by a Medical and Educational Goods and Services grant from Novartis Pharmaceuticals UK.
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Ramparsad, Mr Nitish and Sharma, Dr Varun and McSharry, Dr Charles and Thomson, Professor Neil and Chaudhuri, Dr Rekha and Yang, Dr Freda and Shepherd, Professor Malcolm
• Authors: Yang, J. F., Chaudhuri, R., Thomson, N. C., Ramparsad, N., O'Pray, H., Barclay, S., MacBride-Stewart, S., McCallum, C., Sharma, V., McSharry, C., Murray, D., Shepherd, M., and Lee, W.-T. N.
• College/School: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Robertson Centre; College of Medical Veterinary and Life Sciences > School of Infection & Immunity; College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
• Journal Name: npj Primary Care Respiratory Medicine
• Publisher: Nature Publishing Group
• ISSN: 2055-1010
• ISSN (Online): 2055-1010
• Copyright Holders: Copyright © 2018 The Authors
• First Published: First published in npj Primary Care Respiratory Medicine 28:35
• Publisher Policy: Reproduced under a Creative Commons License