Unwarranted global variation in primary care asthma management: Learnings from the 2023 Asthma Right Care survey

Introduction: Asthma affects approximately 262 million people worldwide; approximately 1000 die from asthma attacks each day. The substantial mortality, morbidity, healthcare utilisation, environmental and economic burden caused by asthma are largely avoidable. To obtain a greater understanding of current primary care asthma management globally, a survey was sent to IPCRG members. Methods: IPCRG developed a baseline survey of 15 questions informed by its 8 person-centred statements and Teach the Teacher programmes. It was sent to representatives of its 38 member countries and attendees of a Right Care Summit. 53 responses from respiratory-interested clinicians in primary and outpatient settings in 32 countries were collated and analysed. Results: No trends were observed regarding adherence to guidelines, or in the treatments prescribed. Asthma diagnosis is based on symptoms when primary care does not have access to objective diagnostic tools. While local or national guidelines exist in the majority of surveyed countries, only 35% of the respondents agreed they are frequently implemented in practice, even when primary care is involved in their development. 76% respondents noted the absence of national policies to support the implementation of guidelines. The level of support received by people with asthma also differs between countries: only 13% respondents affirming that inhaler technique training is always offered to patients when a device is prescribed. 48% participants noted that people with asthma are rarely offered an asthma action plan. The medications that can be initiated and prescribed in primary care vary between countries. Discussion: In comparison to IPCRG’s description of good quality asthma care, key elements were reported missing in many of the countries, with variability present throughout asthma management, from diagnosis to treatment. The survey results reiterated the need for social movements such as ‘Asthma Right Care’ to address the inequity and inequality that remain in asthma management.