Breaking the vicious circle—the Asthma Referral Identifier (ReferID) tool

Abstract

Asthma is associated with a significant burden of disease, especially for patients with severe or uncontrolled asthma. Many patients with severe asthma still receive treatment in primary care settings and despite the availability of effective options, inadequate asthma treatment remains a concern, particularly the use of systemic corticosteroids to treat exacerbations and severe asthma. Around the world, many patients are stuck in a vicious circle of misdiagnosis, undertreatment, and poor understanding of disease severity and management. In this manuscript, we describe the development of The Asthma Referral Identifier (ReferID) tool, a simple, 4-item questionnaire that healthcare providers can use to help identify patients with uncontrolled and/or potentially severe asthma. ReferID was developed specifically for use in primary care clinics in low- and middle-income countries and other clinics, where the optimisation of asthma assessments and treatment recommended for countries with well-established healthcare systems, are not possible. ReferID was developed through an informal collaborative process involving international asthma experts as well as general practitioners, nurses, and specialists throughout the Asia Pacific, Latin America and Middle East regions, in conjunction with current evidence and treatment guidelines. In collaboration with local and regional partners around the world, the developers have adapted ReferID and translated it into 21 languages, and implementation is ongoing in 30 countries. ReferID has the potential to help break the vicious circle, improving disease outcomes and health-related quality of life for patients with asthma.

A Charter to Fundamentally Change the Role of Oral Corticosteroids in the Management of Asthma

“…An indication on a patient record of more than 500 mg over 12 months should trigger a medication review and specialist referral, once optimization measures in primary care have been exhausted. Available tools such as ReferID can also help identify patients in need of optimization [73,74]. The FOCUS Working Group, a subgroup of the PRECISION program with a specific focus on OCS stewardship, agreed on the proposed threshold for OCS use, using existing literature to identify a threshold for action.…”

“…This may be determined by current local practice or guideline. One example is the recently developed ReferID [73,74].…”

The burden of systemic corticosteroid use in asthma management in Asia

“…83 Resources such as the Asthma Referral Identifier (ReferID) tool-a simple, 4-item questionnaire to aid clinicians in identifying patients with uncontrolled and/or potentially severe asthma-could be used to identify patients who would benefit from specialist review. 94…”

“…Adherence to treatment guidelines could be aided in clinical practice by easy‐to‐follow diagnostic and treatment algorithms that include guidance on effective incorporation of ICS, when best to step patients up to stronger formulations such as biologics (or SCS if required) and/or when to refer patients to specialty care 83 . Resources such as the Asthma Referral Identifier (ReferID) tool—a simple, 4‐item questionnaire to aid clinicians in identifying patients with uncontrolled and/or potentially severe asthma—could be used to identify patients who would benefit from specialist review 94 …”

Update in the Management and Treatment of Adult Asthma for Primary Care Physicians

“…The ReferID tool shown in Figure 2 provides a quick method to assess patients in-office. 42 The criteria for reassessing patients with this tool to evaluate for severe asthma include having two or more exacerbations per year, use of OCS twice per year or in a maintenance fashion, a history of having been admitted to an ICU or intubated and using three or more SABA per year. The primary care practitioner (PCP) is not expected to be involved in choosing or monitoring biologic therapy for asthma, but the PCP should identify those who would benefit from consideration of these therapies and make the appropriate referral.…”