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Unclear guidelines mean four in five patients with severe asthma do not get proper care

Some four out of five people in England with severe asthma are not getting the care they need as a result of unclear clinical guidelines, a report by Asthma UK has said.

The report, published on 21 August 2019, used data from the Clinical Practice Research Datalink to determine that just 18% of patients with severe asthma — classified as those prescribed high-dose inhaled corticosteroids — were referred to asthma specialists in secondary care.

The remaining 82% of patients with severe asthma are losing out on “treatments that could transform their lives”, such as monoclonal antibodies that can only be prescribed by specialist clinicians and have the potential to halve the number of asthma attacks a patient has, the report said.

It concluded that patients are not being referred to secondary care because existing guidelines from the National Institute of Health and Care Excellence (NICE) fail to include criteria around when those with serve asthma should be referred.

Referral thresholds in alternative guidelines from the British Thoracic Sociality and the Scottish Intercollegiate Guidelines Network are also unclear, so clinicians have “differing perceptions” of when patients with severe asthma should be referred, leading to variation in referral rates.

Andy Whittamore, clinical lead at Asthma UK, said: “Many people with suspected severe asthma can feel frustrated and helpless because of continuous symptoms and ineffective treatments.

“If someone’s symptoms cannot be controlled, or they have more than two flare-ups requiring oral steroids, healthcare professionals should consider referring their patient to a specialist asthma clinic,” he added.

NICE has been approached for comment.

Citation: The Pharmaceutical Journal DOI: 10.1211/PJ.2019.20206983

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