Two clinicians engaging in conversation in a medical office.

Severe Asthma: Clinical Management and Primary Care

Severe asthma in clinical practice

Primary care clinicians play a key role in asthma and asthma exacerbation management. However, the high burden of asthma exacerbations persists in many patients despite treatment optimisation and adherence to prescribed therapies and important practice gaps still remain. 1

The National Review of Asthma Deaths (NRAD) found 19% of asthma deaths were linked to potentially avoidable specialist‑care access failures. Timely review and referral of patients with severe asthma in primary care is key however, referral rates for specialist care in the UK are low. 1

It is essential to address modifiable factors such as inhaler technique (assessing and educating patients to ensure correct use), medication adherence (supporting and counselling to improve adherence), smoking status (advising cessation and providing resources) and comorbidities (identifying and managing conditions that worsen control). Focusing on these areas can reduce exacerbations and ease the burden on both patients and healthcare services. 2,3

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The Airway Files Podcast series: coming soon

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The challenges of OCS stewardship

While OCS remain a key treatment for acute asthma exacerbations, frequent or long-term use
is associated with a range of systemic complications including adverse events, chronic conditions (e.g., osteoporosis, diabetes), increased mortality and higher healthcare costs. 5–7 Those on long term OCS or requiring frequent courses (eg, 3–4 per year) are at particular risk of systemic side effects. 8

Despite guidance to minimise OCS in severe asthma, many patients still receive prolonged or repeated courses due to system gaps (poor cross provider monitoring, limited stewardship, delayed specialist referral) and patient concerns or reliance on OCS for symptom control. 6

The objective of management in these patients should move beyond short-term exacerbation rescue toward addressing the underlying airway inflammation.

For further information, see additional resources on OCS use in severe asthma

Further information
Doctor consulting with a patient in a medical office.

Asthma and OCS use
in primary care

Overuse of OCS remains a challenge in severe asthma care. How can we optimise inhaled corticosteroid adherence, improve inhaler technique and take a more proactive approach to management?

Dr Katherine Hickman, Respiratory Lead for West Yorkshire ICB and Primary Care Clinical Lead for the National Respiratory Audit Programme, shares practical insights from a primary care perspective.

Disclosures
No disclosures
NP-GB-ASU-VID-230004 | April 2025

Primary care and severe eosinophilic asthma: Referrals and OCS use

When is the right time to refer patients with severe asthma and what signs should HCPs in primary care look for?

In this short video, Dr Pujan Patel, Consultant in Respiratory Medicine at Royal Brompton Hospital, London, shares reflections on referral pathways, OCS use and the barriers to achieving optimal care.

Disclosures
Dr Patel has received a fee from GSK to create this content. Dr Patel has received honoraria for Advisory Board and Speaker fees from AstraZeneca, GSK, Novartis and Teva.
NP-GB-ASU-VID-250003 I April 2025

Severe asthma

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Challenges and goals

Challenges in the treatment of severe asthma and goals for management of care.

Learn more
Two scientists in lab coats work together at a lab bench, examining samples and recording results.

IL-5 and type 2 inflammation

The pathophysiological processes and cellular impact of type 2 inflammation and IL-5 in severe asthma.

Learn more

Abbreviations

HCP, healthcare professional; OCS, oral corticosteroid. 

References

  1. Ryan D, et al. J Allergy Clin Immunol Pract 2021;9:1612–1623.e9;
  2. PCRS. New BTS/NICE/SIGN asthma guideline 2024. Available from: https://www.pcrs-uk.org/sites/default/files/resource/New_asthma_guidelines_first_steps.pdf (Accessed April 2026)
  3. Global Initiative for Asthma. 2025 Global Strategy for Asthma Management and Prevention. Available at: https://ginasthma.org/reports/ (Accessed April 2026)
  4. National Institute for Health and Care Excellence. Asthma pathway (BTS, NICE, SIGN) 2024. Available from: https://www.nice.org.uk/guidance/ng244/chapter/Managing-difficult-and-severe-asthma (Accessed March 2026);
  5. Haughney J, et al. Adv Ther 2023;40:2577–2594;
  6. Canonica GW, et al. Allergy 2025;80:2113–2127;
  7. Wang E, et al. Chest 2020;157:790–804;
  8. Price DB, et al. J Asthma Allergy 2018;11:193–204.

Adverse events should be reported. Reporting forms and information can be found at https://yellowcard.mhra.gov.uk or search for MHRA Yellowcard in the Google Play or Apple App store. Adverse events should also be reported to GSK on 0800 221 441 or UKSafety@gsk.com

June 2026 | NP-GB-ASU-WCNT-250002 (V3.0)