Late Breaking Abstract - Pharmacological and clinical management of severe asthma in 9 countries: An international survey of clinicians

Objectives: Robust, system-level information on the diagnostic, prescribing and care practices in severe asthma (SA) is scarce. We aimed to: i) identify the available and relevant evidence on the clinical and pharmacological management of SA and ii) understand the opportunities for targeting new treatment pathways in SA. Methods: A framework of 44 indicators on SA diagnosis, treatment and care was built. An international web-survey of respiratory specialists captured information on national diagnostic and treatment pathways, and policies in SA care delivery. We performed a comparative analysis and benchmarking of performance in SA across 9 countries. Results: Twenty-six responses were received from Australia, Brazil, Canada, France, Germany, Italy, Japan, Spain and UK. Discrepancies existed across and within countries on whether specialist referral occurs before (69% of respondents) or after (31%) SA diagnosis. Referral times ranged from 1 to 24 months. Variation was more prominent in the diagnostic criteria and tests used, while only 30% of respondents reported using SA diagnostic pathway guidelines. Key reasons influencing biologic prescribing include the need for maintenance Oral Corticosteroid (OCS) therapy and/or excess of 2 OCS bursts in 12 months (96% and 70% of respondents respectively). Time of biologic initiation varied between 0-2 (15%), 3-6 (46%), 7-12 (30%) and more than 12 (9%) months after SA diagnosis respectively. Conclusion: Improved referral pathways and capacities in SA are needed. SA care could also benefit from measures to support increased understanding and incentivisation of guidelines in the prescribing of biologics and SA diagnostic criteria.