Reducing the hidden burden of severe asthma: recognition and referrals from primary practice

Marc Humbert* (Corresponding Author), Arnaud Bourdin, Nikolaos G. Papadopoulos, Stephen T. Holgate, Nicola A. Hanania, David M.G. Halpin, Kenneth R. Chapman, Marcela Gavornikova, David B. Price, Alan Kaplan, Liam G. Heaney

*Corresponding author for this work

Research output: Contribution to journalComment/debate

1 Citation (Scopus)

Abstract

Since their introduction many decades ago, systemic corticosteroids have become a mainstay treatment for asthma. Despite being a highly effective therapy, corticosteroids can cause significant adverse effects in patients. This results in a “double hit” for some patients as they suffer the burden of disease as well as the burden of treatment-induced morbidity. This article aims to raise awareness of the potential, harmful side effects of prolonged or repeated exposure to systemic corticosteroids in asthma. It also highlights the importance of referral of the appropriate patients with asthma from primary care for specialist assessment once other considerations such as adherence, inhaler technique and co-morbidity have been evaluated. We propose a simple decision step that may help busy primary care physicians and general practitioners to identify patients who could benefit from specialist assessment. Our decision step suggests that a patient with asthma should be reviewed at least once by an asthma specialist if he/she (i) has received ≥2 courses of oral corticosteroids in the previous year; asthma remains uncontrolled despite good adherence and inhaler technique; or (ii) has attended an emergency department or was hospitalized for asthma care. Such referral could facilitate wider access to diagnostic tools, in-depth assessment of confounding comorbidities, and non-corticosteroid-based therapies as needed, which may be unavailable in primary practice.

Original languageEnglish
Number of pages6
JournalJournal of Asthma
Early online date13 May 2020
DOIs
Publication statusE-pub ahead of print - 13 May 2020

Keywords

  • decision step process
  • general practitioner
  • non-corticosteroid therapy
  • primary care
  • referral
  • specialist
  • Systemic corticosteroids
  • MULTICENTER
  • MEPOLIZUMAB
  • MANAGEMENT
  • EFFICACY
  • SAFETY
  • INHALED CORTICOSTEROIDS
  • BENRALIZUMAB
  • DOUBLE-BLIND
  • EXACERBATIONS

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    Humbert, M., Bourdin, A., Papadopoulos, N. G., Holgate, S. T., Hanania, N. A., Halpin, D. M. G., Chapman, K. R., Gavornikova, M., Price, D. B., Kaplan, A., & Heaney, L. G. (2020). Reducing the hidden burden of severe asthma: recognition and referrals from primary practice. Journal of Asthma. https://doi.org/10.1080/02770903.2020.1759084