Triggers for referral for poorly controlled and severe asthma

Key facts

• Asthma UK suggests that an estimated 5.4 million individuals are living with asthma in the UK.
• Someone has a potentially life-threatening asthma attack in the UK every 10 seconds and 185 people are admitted to hospital every day.
• The number of asthma-related deaths in England and Wales has barely changed in the last 20 years from 1,268 in 2001 to 1,320 in 2017. The picture is similar in Scotland with 101 deaths in 2001 and 126 in 2017.
• The cost of caring for individuals with asthma now exceeds £1.1 billion each year, the majority of these being spent on prescription medications and primary care consultations.

Severe asthma is increasingly regarded as a distinct disease entity and may be driven by different inflammatory pathways from those driving asthma in the majority of patients. For these patients, alternative treatments are needed that target different inflammatory pathways to those targeted by inhaled and OCS.  This document provides information on poorly controlled and severe asthma and outlines triggers for referral for adult/paediatric specialist care.

The document explores:

• What is severe and uncontrolled asthma and indicators of poor control?
• When should we refer our asthma patients for specialist review?
• How we can determine when our asthma patients need specialist referral
• Managing this patient group (including those who do not attend clinic reviews)
• Appropriate patient education