Severe asthma: A call for global policy action

Why is it that a disease as common as asthma, which affected approximately 262 million people globally in 2019,¹ is so misunderstood? Few policymakers understand the significant risks associated with poorly controlled severe asthma. As a patient advocate and a pulmonologist, we are deeply concerned that it remains a dangerously overlooked public health issue.

Asthma is often considered a mild condition. So it might surprise you to learn that it causes a staggering 1,000 deaths a day worldwide.² Despite this, asthma care continues to be sub-optimal.³ Clinical practice guidelines are not adopted or adhered to universally,⁴ and the condition is rarely prioritized by policymakers. Moreover, asthma is not unique in these challenges, which are reflected across all chronic respiratory diseases.

While more attention is needed for all people living with asthma, severe asthma is our focus here, because it disproportionately contributes to high levels of illness and death and it drives a substantial amount of health system costs.^5-8

Severe asthma is a distinct condition requiring urgent action

Severe asthma is a much more serious form of asthma that generally does not respond well to standard asthma therapy.⁹ Despite receiving maximum levels of standardized treatment, some people with the condition experience repeated, unpredictable, life-threatening asthma attacks, and continually struggle to breathe.^10-12

Up to 57 percent of people living with the condition have poorly controlled disease, often due to ineffective treatment or misdiagnosis.^{3, 12, 13} Additionally, more than 50 percent of people with severe asthma are also living with three or more other conditions.¹⁴ Severe asthma can hugely limit an individual’s ability to work and socialize with friends and loved ones.¹⁰ It is no wonder, then, that the condition has such a detrimental effect on a person’s quality of life.^12-15

Yet severe asthma remains poorly recognized and misunderstood, not only in terms of the burden it places on individuals, societies and economies, but also with regard to the need for timely access to high-quality, specialist care.

It is unthinkable that some people living with severe asthma can cycle through the health system for over five years before seeing a specialist.¹⁷ This is most likely one of the reasons that only 20 percent of those eligible severe asthma patients, receive a targeted therapy i.e. a biologic.¹⁸ But this is the reality for many people living with the condition. Treatments for severe asthma tend to focus on acute symptoms or exacerbations rather than underlying causes; this is largely because it is not identified as a distinct condition by healthcare professionals.¹⁹ The resulting over-reliance on, and continued use of, oral corticosteroids can lead to significant short- and long-term adverse effects,²⁰ including conditions such as osteoporosis, cardiovascular disease, diabetes and depression.¹⁴

The major delays in diagnosis for severe asthma, lack of clear referral criteria and variations in access to effective treatments are unacceptable.

Change is possible and much-needed: Opportunities for policy action

In light of the current state of affairs, experts in respiratory health have come together to establish a global multi-stakeholder alliance, the Severe Asthma Policy Group. Ultimately, the Group aims to improve lives, and seeks to do so by advancing policy engagement to ensure that timely, equitable and high-quality care for people living with severe asthma is an integral part of every health system.

To achieve this we need to improve education and raise awareness of what appropriate and high-quality care looks like for severe asthma. This will empower people living with the condition, so they can advocate for themselves and self-manage. It will also help healthcare professionals identify people who would benefit from specialist intervention, and refer them accordingly. Finally, it will encourage policymakers to advocate for change.  

This important work has already begun with three significant resources: the Global Quality Standards for Identification and Management of Severe Asthma were published in 2020;³ a patient charter on severe asthma was released in 2022;¹⁹ and a report, A breath of fresh air: addressing missed opportunities in severe asthma care, was launched in 2023.²¹ All three publications illustrate where improvements must be made and what best-practice care should look like for severe asthma.

To complement these publications — and to galvanize policy advocacy on severe asthma in the respiratory community — the Severe Asthma Policy Group has developed a new call to action urging governmental institutions and policymakers to:

• implement existing clinical guidelines and quality standards^3,9,11 for severe asthma care at the national level;
• drive the establishment of clear referral criteria and the implementation of streamlined care pathways so that patients reach specialists in a timely manner for the appropriate evaluation and optimization of their care;
• enable healthcare professionals to promptly identify people with suspected severe asthma⁹ and provide coordination between primary and specialist care, by ensuring access to adequate training, decision-support tools and knowledge-sharing platforms;
• collaborate with national respiratory patient organizations to raise awareness of and improve education about severe asthma for everyone living with the condition;
• tackle inequities and disparities in access to severe asthma care by targeting communities with the poorest outcomes;
• develop comprehensive national respiratory disease strategies that enable reliable data collection and include specific, measurable goals for the prevention, early diagnosis, treatment and care of severe asthma.

We must act now

The message is clear: We know what needs to be done in severe asthma, and we can do better.

We must do right by people living with severe asthma so they can lead the active and fulfilled lives they deserve.