Patients with difficult and severe asthma are slipping through the net

Patients with difficult and severe asthma are often failing to get the specialist assessment, support and treatment they need, says a new report by Asthma UK.

Slipping through the net: The reality facing patients with difficult and severe asthma identifies several problems including:

• Difficulties in aligning and sharing data across the healthcare system
• Difficulty differentiating between difficult and severe asthma
• Lack of clinical consensus on when to refer patients with suspected difficult/severe asthma
• Problems fulfilling the NHS England service specification.

The main barrier to better care is the lack of consensus on the actual number of people in the UK who have difficult and severe asthma.

The report is based on interviews with 17 severe asthma clinicians and a survey of 72 primary and secondary health care professionals.

It concludes: “Many of the issues we identified through these interviews with severe asthma clinicians echo those from the 2014 National Review of Asthma Deaths (NRAD) report, and it is worrying that, four years later, many of the problems identified in the report have not been addressed.”

Recommendations include:

• Agree clear definitions of the different types of ‘severe’ and ‘difficult’ asthma to allow clinicians and people with asthma to understand the best management approach
• Accurately determine the size of the UK difficult and severe asthma populations to allow effective service planning
• Develop clear referral criteria between general practice, hospitals and specialist centres

PCRS-UK Chair, Dr Noel Baxter, who contributed to the report, says: “It’s time we supported general practice more than we do currently do to help stratify the patients who may need more than can be offered with usual and good quality primary care. Clarity around referral criteria and what can be expected of specialist asthma interventions is needed”