Is there sufficient need for an adult severe asthma service in the UK? a review of 11 UK family practitioners

Background: GINA¹ and the British Thoracic Society (BTS) guidelines² recommend severe asthma patients be defined as those with uncontrolled asthma despite receiving high dose inhaled corticosteroids (ICS) plus long-acting β₂ agonists (LABA). According to guidelines, these patients should be referred to a severe asthma service. To date it is unclear how many patients would need this service.

Aim: Determine how many patients would be eligible for an adult severe asthma service using the GINA definition of uncontrolled asthma.

Methods: Optimum Patient Care (OPC) provides an electronic asthma review service for UK family practitioners. OPC software collects, collates and generates reports from 1) electronic routine data and 2) patient reported questionnaire data. Data were analysed to identify patients by asthma treatment, patients at high risk of exacerbation (≥1 hospitalisation or ≥2 rescue courses of oral steroids in last year) and asthma control (defined according to GINA guideline definitions: Controlled, Partly controlled and Uncontrolled).

Results: 11 GP practices from Surrey Primary Care Trust were reviewed. 5134 asthma patients, from a patient population of 112,272, were identified (prevalence: 4.57%). 4451 were adults (aged ≥18 years), of which 720 (16%) were receiving high dose ICS and LABA, and 8 (0.2%) were also receiving long term oral steroids. 41 were considered high risk. Results using the GINA guideline definitions of control are shown in Table 1. Extrapolating to PCT level (1,154,068 patients), 1696 (226 High risk), uncontrolled patients would require referral to a severe asthma service.

Table 1: Results for GINA definition of Control

GINA definition of Control	Patients n (%)	High Risk n (%)
Controlled	25 (4.3%)	1 (2.63%)
Partly Controlled	391 (67.3%)	15 (39.5%)
Uncontrolled	165 (28.4%)	22 (57.9%)
Total with available data	581 (100%)	38 (100%)
Data Unavailable	147	3

Conclusion: In the practices reviewed, there is an unmet need for referral to a severe asthma clinic. Use of GINA criteria for asthma control are dependent upon data collection.

¹http://www.goldcopd.com/download.asp?intId=554

²http://www.brit-thoracic.org.uk/Portals/0/Clinical%20Information/Asthma/Guidelines/
sign101%20revised%20June%2009.pdf