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.

英国国家哮喘死亡评论（NRAD）建议在过去的一年中需要≥3个疗程的口服皮质类固醇（OCS）加重病情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专科哮喘服务。这项研究的目的是确定在初级保健中符合NRAD专业转诊标准的哮喘患者的比例以及与频繁发作相关的因素。从格拉斯哥10个初级保健机构共有2639名成人哮喘患者，英国进行回顾2014年和2015年经常exacerbators和短效β之间的研究₂如果在过去的一年中分别接受了≥2次确诊的OCS哮喘病治疗和≥13次SABA吸入剂，则确定了SABA过度使用者。社区配药数据用于评估治疗依从性，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％）频繁发作的急性发作者，137名（5％）SABA过度使用者和319名（12％）接受BTS Step 4/5治疗的患者。在频繁发作的患者中，有41％的患者需要接受BTS步骤4/5的治疗，有46％的患者对ICS的依从性欠佳，有42％的患者在过去的一年中没有参加过哮喘复查，有42％的患者以前没有接受过专门的哮喘治疗。老年人，女性，BTS步骤4/5，过度使用SABA和并存的COPD诊断增加了频繁发作的风险。每100名哮喘患者中有14名符合NRAD专家推荐标准。需要改善初级和二级保健哮喘服务之间的协作以改善慢性哮喘保健。