Title:Expert Opinion for the Management of Severe Asthma in Adults in the
Gulf Region
Volume: 18
Issue: 3
Author(s): Ashraf Alzaabi*, Marwan Najib, Hala Samaha, Thiagarajan Jaiganesh, Abeer Kassem and Ahmed Abbas
Affiliation:
- Division of Respirology, Zayed Military Hospital, Abu Dhabi, United Arab Emirates
- Department of Internal Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
Keywords:
Severe asthma, Gulf countries, primary care physicians, exacerbations, referral to a specialist, referral guideline.
Abstract: Asthma is a noncommunicable, chronic respiratory disease affecting 339 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.