The United Kingdom National Review of Asthma Deaths (NRAD) recommends that patients who require ≥3 courses of oral corticosteroids (OCS) for exacerbations in the past year or those on British Thoracic Society (BTS) Step 4/5 treatment must be referred to a specialist asthma service. The aim of the study was to identify the proportion of asthma patients in primary care that fulfil NRAD criteria for specialist referral and factors associated with frequent exacerbations. A total of 2639 adult asthma patients from 10 primary care practices in Glasgow, UK were retrospectively studied between 2014 and 2015. Frequent exacerbators and short-acting β₂-agonist (SABA) over-users were identified if they received ≥2 confirmed OCS courses for asthma and ≥13 SABA inhalers in the past year, respectively. Community dispensing data were used to assess treatment adherence defined as taking ≥75% of prescribed inhaled corticosteroid (ICS) dose. The study population included 185 (7%) frequent exacerbators, 137 (5%) SABA over-users, and 319 (12%) patients on BTS Step 4/5 treatment. Among frequent exacerbators, 41% required BTS Step 4/5 treatment, 46% had suboptimal ICS adherence, 42% had not attended an asthma review in the past year and 42% had no previous input from a specialist asthma service. Older age, female gender, BTS Step 4/5, SABA over-use and co-existing COPD diagnosis increased the risk of frequent exacerbations independently. Fourteen per 100 asthma patients would fulfil the NRAD criteria for specialist referral. Better collaboration between primary and secondary care asthma services is needed to improve chronic asthma care.

英国国家哮喘死亡审查 (NRAD) 建议，过去一年因病情加重需要 ≥3 个疗程口服皮质类固醇 (OCS) 的患者或接受英国胸科学会 (BTS) 步骤 4/5 治疗的患者必须转诊至哮喘专科服务。该研究的目的是确定初级保健中符合 NRAD 专家转诊标准的哮喘患者比例以及与频繁恶化相关的因素。 2014 年至 2015 年间，对来自英国格拉斯哥 10 个初级保健诊所的总共 2639 名成年哮喘患者进行了回顾性研究。如果他们接受了 ≥2 个经确认的 OCS 疗程，则可识别出频繁的加重者和短效 β ₂受体激动剂 (SABA) 过度使用者去年分别用于治疗哮喘和 ≥13 个 SABA 吸入器。社区配药数据用于评估治疗依从性，治疗依从性定义为服用≥75%的处方吸入皮质类固醇 (ICS) 剂量。研究人群包括 185 名 (7%) 频繁加重者、137 名 (5%) SABA 过度使用者和 319 名 (12%) 接受 BTS Step 4/5 治疗的患者。在频繁的病情加重者中，41% 的人需要 BTS 步骤 4/5 治疗，46% 的人 ICS 依从性不佳，42% 的人在过去一年中没有参加过哮喘检查，42% 的人以前没有接受过哮喘专业服务的输入。年龄较大、女性、BTS Step 4/5、SABA 过度使用和共存 COPD 诊断独立增加了频繁急性加重的风险。每 100 名哮喘患者中就有 14 名符合 NRAD 专科转诊标准。初级和二级哮喘护理服务之间需要更好的合作，以改善慢性哮喘护理。