Asthma is a common problem in primary care. Most people can achieve adequate control in this setting by attention to self-management skills and adherence to maintenance inhaler therapy. The role of the primary care physician in severe asthma management is to recognise which people with uncontrolled asthma have treatment-refractory disease, and partner with specialist centres to manage these patients. When a severe asthma diagnosis is confirmed or suspected, referral to a specialist centre is recommended. This will facilitate systematic assessment, management of aggravating factors and trial of additional therapies.
What prompts a specialist referral in people with confirmed asthma on optimal treatment?
- Anyone using more than one 5-7 day course of prednisone in any 12 month period
- Recent hospital admission for an asthma attack
- Persistent uncontrolled symptoms, despite being on treatment
It’s also important to consider early referral to a respiratory specialist when control is not achieved on medium dose ICS/LABA. This way a specialist assessment can enable early intervention which could minimise the progression of asthma and improve quality of life. Early referral can:
- Assess adherence, technique, triggers
- Assess presence of T2 inflammation (blood eosinophils, FeNO)
- Consideration of high dose ICS and referral for biologic assessment
