Background: In the UK, many asthma patients have frequent exacerbations resulting in admission to hospital, which could otherwise be prevented with appropriate management regimens.

Objectives: We aimed to determine whether frequent asthma exacerbators in respiratory follow up were experiencing optimal utilisation of healthcare, including being referred to tertiary care where appropriate.

Methods: We collated a list of patients who had been admitted to a district general hospital with at least 1 exacerbation of asthma between 2017 and 2022. We took the top 104 asthma exacerbators from this list, and analysed their baseline characteristics, asthma phenotypes, and healthcare utilisation. This subsequently allowed us to determine whether these patients were receiving the ideal asthma management for their phenotype.

Results: Out of 104 patients reviewed, 88 were in respiratory follow up. 73% of patients had an eosinophilic asthma phenotype, and 29.8% had raised IgE. 64% of patients required more than 1 course of oral steroids per year to manage their asthma. Out of 22 eligible patients, only 11 had been referred to tertiary care for biologic therapy.  

Conclusions: Patients frequently admitted to hospital with asthma exacerbations are receiving suboptimal care, with 50% of eligible patients not being referred for biologic therapy. This suggests that the focus of secondary care asthma management should be directed towards appropriate referral to tertiary care, to prevent use of multiple courses of oral steroids and repeated admissions to hospital.