Expert Opinion for the Management of Severe Asthma in Adults in the Gulf region

Asthma is a noncommunicable, chronic respiratory disease affecting 358 million individuals globally. The SNAPSHOT study suggests a prevalence rate of 6.4% in the Middle East region and 7.6% in the Gulf region alone, causing a significant healthcare burden. The management of severe asthma poses a significant challenge, thus accounting for suboptimal disease control. Diagnosis of severe asthma is quite difficult, considering the multiple factors playing a pivotal role in disease progression and management. Primary care physicians (PCPs) are predominantly involved in decision-making in asthma diagnosis and control. Therefore, educating the PCPs regarding diagnostic strategies and guiding them for a timely referral to specialists can reduce fatal episodes and disease exacerbations. In this way, PCPs may ensure effective treatment and achieve optimal disease control. To develop an algorithm and decision tree that may aid PCPs in the timely referral of severe asthma patients to specialists, an expert committee meeting was convened in December 2020 with leading experts from the United Arab Emirates. A three-step algorithm “CAR” was established to guide PCPs: “confirm” and check diagnosis, “assess” factors contributing to exacerbations and poor quality of life, and “refer” to a specialist. The “Severe Asthma Referral approach” conceptualized herein for the PCPs may help overcome the pragmatic challenges of early diagnosis, establish simple referral criteria for specialists, and attain severe asthma treatment goals.