Living in limbo

The scale of unmet need in difficult and severe asthma

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Many people with asthma have a form of the condition (known as difficult and severe asthma) that cannot be managed in primary care. For people with ‘severe’ asthma, their condition means their asthma is resistant to usual treatments and requires high dose steroid tablets that have serious side effects. People with difficult and severe asthma require management in secondary and tertiary care (local or regional hospitals) and may be eligible for new drugs known as monoclonal antibodies (mAbs). However, access to this crucial care is uneven.

Our new report, Living in limbo: The scale of unmet need in difficult and severe asthma, outlines the size of the unmet need in difficult and severe asthma services. We analysed data including health surveys, hospital appointments and prescribing records to find out the scale of the unmet need for a group at particular risk of life-threatening asthma attacks.

Our analysis found that only 18% of adults with possible difficult and severe asthma are getting referred for specialist treatment in line with clinical guidelines. For the first time, we are also able to estimate that about 48,000 people are currently missing out on these new, life-changing treatments. People with the most devastating form of the condition are not receiving the care they need, and this needs to change.

Top recommendations

In this report, we recommend:

    • The development of clear referral guidelines coupled with raised awareness for clinicians
    • A review of capacity in secondary and tertiary care based on the unmet need highlighted in this report and the commissioning of new asthma services as required
    • Ensuring appropriate access to new biologic treatments to address the unmet need outlined in this report

Download our report [PDF] to read our full recommendations and analysis.

Download the report

Download the report appendices

Our latest severe asthma report

Our 2020 report Falling into isolation: lived experience of people with severe asthma finds that living with severe asthma is so much more than asthma attacks and occasional hospital admissions.

Our previous difficult and severe asthma reports

Our 2018 report Slipping through the net: The reality facing patients with difficult and severe asthma used interviews with asthma clinicians and a clinician survey to find out about the care that people with difficult and severe asthma receive.

Our 2017 report Severe asthma: the unmet need and the global challenge focused on making new treatments for severe asthma available more quickly and the need to better identify the different types of severe asthma.