Asthma Referral Identifier
Developed by AstraZeneca in collaboration with five asthma experts. ReferID supports Healthcare Professionals to identify adult asthma patients who may benefit from a referral for specialist review.
ReferID also includes guidance to aid understanding of asthma management and control.
Date of preparation January 2023
Asthma Referral Identifier
EMERGENCY VISITS
Has the patient had 2 or more emergency attendances/ unscheduled visits due to asthma over the past 12 months?
INTENSIVE VISITS
Has the patient ever been intubated or admitted to an ICU (intensive care unit) or a high dependency unit due to their asthma?
SABA USE
How many SABA (short-acting beta2-agonist) inhalers has the patient used over the past 12 months?
Guidance
The following sections provide guidance on how to optimise the management of your patient’s asthma based on the Global Initiative for Asthma (GINA) Global Strategy for Asthma Management and Prevention 2022.
You may also wish to reference the National Asthma Council (NAC) Australian Asthma Handbook.
Asthma symptom control
It is important to assess the patient’s level of symptom control. Poor symptom control is a burden to patients and a risk factor for exacerbations.
The following notes give an outline of this topic. For comprehensive information, please refer to relevant sections of the GINA report.
Checking patient’s symptom control
These questions help to assess the patient’s level of control. Please note that there are alternative symptom control instruments available. Please refer to local or national guidelines for the advice on which one is recommended in your area.
In the last 4 weeks, did the patient:
- Have any daytime symptoms more than twice a week?
- Experience any night waking due to asthma?
- Need their reliever more than twice a week?
- Have any day-to-day activity limitation?
Interpreting the patient’s answers
The patient’s level of control is measured against the frequency of their symptoms. Count how many of the questions are answered by a ‘yes’ and use the reference below to assess the level of control:
-
No ‘yes’ answers
The patient is well controlled -
1–2 ‘yes’ answers
The patient is partly controlled -
3–4 ‘yes’ answers
The patient is uncontrolled
Treatment step
The treatment step can be an indicator of severity. Therefore, it is important to understand which treatment step your patient is on.
The following notes give an outline of this topic. For comprehensive information, please refer to relevant sections of the GINA report and the NAC Australian Asthma Handbook.
Identify treatment step
The inhaled corticosteroid (ICS) based maintenance inhalers that the patient is prescribed can be used as a guide to identify that patient’s treatment step. You can refer to the list below for a quick check to understand which treatment step your patient is on.
-
Step 3 treatment
Low dose ICS-long-acting beta2-agonist (LABA) -
Step 4 treatment
Medium / high dose ICS-LABA -
Step 5 treatment
Add-on LAMA and/or specialised treatments
Please refer to asthma treatment guidelines (GINA report or NAC Australian Asthma Handbook) for a definition of low, medium and high dose ICS.
Adherence
Approximately 50% of adults and children do not take their ICS maintenance inhaler medications as prescribed. This can lead to poor symptom control and exacerbations.
Therefore, it is important to understand if patients are taking their medicines correctly in order to properly optimise their asthma management.
The following notes give an outline of this topic. For comprehensive information, please refer to relevant sections of the GINA report.
Checking patient’s adherence
Understanding if a patient is adherent to their treatment requires probing about their daily routines and behaviours. Some example questions to help identify their level of adherence are provided below:
Does the patient:
- Forget to take their ICS maintenance inhaler more than twice a week?
- Not use their ICS maintenance inhaler as prescribed?
- Fail to pick up their prescriptions?
- Over-use their reliever inhaler and under-use their ICS maintenance inhaler?
It is also important to check the patient’s medication usage, prescription date, inhaler date, dose counter or dispensing records.
Inhaler technique
Most patients (up to 80%) do not use their inhaler correctly. This can contribute to poor symptom control and exacerbations. Therefore, it is important to check the patient’s inhaler technique at regular intervals.
The following notes give an outline of this topic. For comprehensive information, please refer to the NAC Australian Asthma Handbook.
Checking inhaler technique
Different inhaler types may require differing usage techniques. Please ensure you check the patient’s inhaler and follow the correct technique according to the manufacturer’s instructions.
Ask the patient to demonstrate their technique using a placebo device. If their technique is sub-optimal, demonstrate the correct technique and then ask the patient to repeat 2–3 times or until their technique is optimal.
Risk factors
Assessing the patient’s risk factors and comorbidities will help personalise their asthma care.
Please consider discussing topics such as asthma triggers, comorbidities and socioeconomic factors.
For comprehensive information, please refer to relevant sections of the GINA report.
Consider review by a specialist
According to the information provided, the Global Initiative for Asthma (GINA) report and expert opinion, it appears the patient would benefit from an asthma review by a specialist.
Before referring the patient check adherence to maintenance therapy and inhaler technique.
For further information, please see the summary below.
This output is based on the GINA report and expert opinion.
Exacerbations history:
- Less than 2 courses of oral corticosteroids (OCS) and/or is using maintenance OCS over the past 12 months
- 2 or more emergency attendances, admissions or unscheduled visits due to asthma over the past 12 months
- History of intubation or admission to an intensive care unit or high dependency unit due to their asthma
- No short-acting beta2-agonist inhalers used in the last 12 months
Also consider
Seek advice from expert clinicians if there is a lack of clarity on issues such as comorbidities and contextual factors. Please refer to the GINA report for further information.
Further Guidance
If you would like to learn more about the factors contributing to asthma management, please find some helpful information based on the GINA report and best practice:
Asthma symptom control >Treatment step >
Adherence >
Inhaler technique >
Risk factors >
The results are below the threshold for a specialist review
According to the information provided, the Global Initiative for Asthma (GINA) report and expert opinion, it is unlikely that the patient needs a specialist review.
For further information, please see the summary below.
This output is based on the GINA report and expert opinion.
There appears to be no need for an urgent review by a specialist.
Exacerbations history:
- Less than 2 courses of oral corticosteroids (OCS) and/or is using maintenance OCS over the past 12 months
- Less than 2 emergency attendances, admissions or unscheduled visits due to asthma over the past 12 months
- No history of intubation or admission to an intensive care unit or high dependency unit due to their asthma
- No short-acting beta2-agonist inhalers used in the last 12 months
Also consider
Seek advice from expert clinicians if there is a lack of clarity on issues such as comorbidities and contextual factors. Please refer to the GINA report for further information.
Further Guidance
If you would like to learn more about the factors contributing to asthma management, please find some helpful information based on the GINA report and best practice:
Asthma symptom control >Treatment step >
Adherence >
Inhaler technique >
Risk factors >