Tackling severe asthma, one step and one breath at a time

Living with severe asthma means living with the fear that a serious problem even life threatening attack could strike anytime, anywhere.

It’s trying to avoid a situation where one day I’ll have a seizure and I’ll be in a place where no one will know what to do with me, explained Lynn, a Canadian who has lived with the disease for 28 years.

Asthma takes an immense personal toll and, with an estimated 16 million people living with a severe form of the disease globally, it also takes a significant toll on healthcare systems and society.1

With an estimated 16 million people living with a severe form of the disease globally, it also has a significant impact on healthcare systems and society.1

While those living with severe asthma account for only about 5-10% of global cases, they account for more than 50% of healthcare costs associated with the condition.1.2

And, as the number of people living with asthma continues to grow worldwide, there is a growing imperative to understand and improve disease prevention and management strategies.

To explore this further, the Copenhagen Institute for Futures Studies (CIFS) undertook the creation of the Severe Asthma Index a first-of-its-kind independent tool for assessing the state of severe asthma care and support in nearly 30 OECD countries worldwide.

We monitored several factors relating to health policy, access and quality of care, clinical and population health indicators, and environmental factors that led to our conclusions, said Bogi Eliasen, director of health at CIFS. Through this overview, we aim to help advocates, clinicians, public health officials and policy makers understand the specific and targeted actions they can take to help improve care for people in their communities affected by severe asthma.

Assessing different countries’ approaches to severe asthma across five different indicator categories, the Index compiled various data sources to support a comprehensive analysis of severe asthma treatment and prevention approaches in each location.

Assessing different countries’ approaches to severe asthma across five different indicator categories, the Index compiled various data sources to support a comprehensive analysis of severe asthma treatment and prevention approaches in each location.

The main results found clear differences between countries, with Australia scoring highest (73/100) followed by France, New Zealand, Italy and the United Kingdom3 Conversely, Latvia obtained the lowest score (48/100), followed by Slovenia, Estonia, Belgium and Slovakia.3

Interestingly, while the results confirmed some expectations, there were also situations where countries ranked higher or lower expected.

For example, Australia’s ranking was as high as expected due to its strong level of implementation of asthma strategies and tobacco control policies.3 Finland (64.8/100), however, ranked lower than expected due to moderate implementation of its asthma strategy, coupled with limited alignment of care guidelines with international best practice and one of the lowest levels of access to care (specialist care and biological medicines).3

We found that the best indicator for a country’s good performance was the soundness of the political environment it already had in place, Eliasen said. Countries with a dedicated severe asthma strategy, comprehensive care guidelines and a severe asthma registry tended to score higher on the Index.

To this end, the Index found that while the majority of countries have some form of severe asthma guidelines, fewer than half have a national strategy for asthma control, prevention and/or management .3

While the majority of countries have some form of guidelines for severe asthma, less than half have a national strategy for asthma control, prevention and/or management.3

Differing alignment with internationally recognized best practices remains a limiting factor in access to care, and the Index shows a clear need for many countries to develop a dedicated and harmonized asthma strategy, Eliasen explained.

A similar lack of alignment was seen in reporting standards and data access specific to severe asthma, making a comprehensive assessment of the burden of disease difficult.3 Considering the significant impact of this disease, such a lack of data and inconsistent data recording was truly surprising, said Patrick Gallen, a futurist at CIFS. One such data area concerns the use of oral corticosteroids (OCS) for the treatment of severe asthma. Chronic use of OCS may indicate that a patient’s disease is not well controlled, however most countries’ health systems still fail to systematically monitor the use of these steroids which can also lead to adverse effects a long-term patient health.

The very lack of this indicator highlights the need for improved data collection and reporting on various aspects of severe asthma, Gallen added. More data is needed to ensure that the OCS can be included in future editions of the Index.

For patients, the country in which they live can also determine the level of access to care with shortcomings in connection with specialists, use of telemedicine and access to adequate diagnostic tools seen most urgently in Japan, Greece, Estonia, Lithuania and Slovenia.3

The problem is not the need for more resources, but a better allocation to deliver consistent quality of care, Gallen explained. For example, more efficient care pathways and reimbursement policies, including access to biological medicines a mainstay of severe asthma treatment could make a greater difference to patient outcomes than a higher investment of other types of resources.

Finally, the Index identified the need to reevaluate how patients receive support, education and tools that empower them in their patient care journey.3 The Index results show that it is crucial that policy makers view severe asthma as more than a clinical phenomenon. Patient outcomes and experiences influence and are influenced by a multitude of systemic, political and environmental factors and this is where the need for a systems approach emerges.

Repairing one area is not enough. We need to take stock of the many needs of those living with and treating severe asthma, to manage it effectively across country populations, Eliasen added.

The current lack of comprehensive and well-implemented national asthma strategies (and the even greater lack of attention for severe asthma) shows the gap that policymakers should urgently address.

Changing the way we define, treat and prevent severe asthma requires significant support from all stakeholders not just healthcare professionals working to address and prioritize severe asthma as a complex and burdensome chronic condition that it is.

MAT-GLB-2302405 v2.0 | July 2023


[1] O. Enilari and S. Sinha, The global impact of asthma in adult populations, Ann Glob Health, vol 85(1), no. 2, 2019

[2] Al Efraij, K. and JM FitzGerald, Current and emerging treatments for severe asthma. J Thorac Dis, 2015. 7(11): p. E522-5.

[3] Copenhagen Institute for Future Studies. (2023). The Severe Asthma Index. [https://www.severeasthmaindex.org/]

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