Severe Asthma: It’s Time to Act for Patients — and Health Systems

Timing transforms outcomes

For people living with severe asthma, outcomes are not determined only by what treatment they receive, but when.¹ Evidence now makes one thing clear: delays in care are costing lives, productivity, and public money — and they are largely preventable.^2,3,4

In diseases such as cancer, heart failure, and chronic kidney disease, policymakers have long recognised the power of time-bound care pathways.^5,6,7 Deadlines for diagnosis, referral, and treatment optimisation are standard practice because they save lives and reduce long-term costs.^5,6,7 Severe asthma, affecting an estimated 33.9 million people globally, has yet to benefit from the same urgency.⁸ That needs to change.

A chronic disease still treated as a crisis

Despite being a well-characterised condition with clear clinical guidelines, severe asthma is still managed too often as a series of emergencies rather than a disease to be proactively controlled.² Patients endure years of breathlessness, repeated exacerbations, and frequent emergency department visits before accessing optimal specialist care.^2,8

Evidence now makes one thing clear: delays in care are costing lives, productivity, and public money — and they are largely preventable.

During this time, many are exposed to prolonged courses of oral corticosteroids — drugs that can be lifesaving in the short term but devastating when used chronically. The consequences are well documented: diabetes, hypertension, osteoporosis, cardiovascular events, and increased mortality risk.⁹ For patients, this means a life constrained by symptoms, anxiety, and side effects. For health systems, it means avoidable cost and escalating demand.³

Perhaps most concerning is that many patients come to accept this situation as inevitable. They stop expecting control.¹⁰ That resignation is not a clinical failure — it is a system failure.¹¹

The case for earlier intervention

A growing body of evidence, reinforced by strong clinician consensus, shows that earlier intervention in severe asthma fundamentally alters outcomes. A recent multinational consensus among 500 healthcare professionals across five countries concluded that patients should move from referral to treatment review within 18 weeks — a clear, achievable benchmark that mirrors time-based standards already used in other chronic diseases.¹²

Yet in reality, patients can wait more than four years from referral before receiving the treatment that is right for them. Those lost years matter.

This consensus represents a turning point. It acknowledges that severe asthma is not a rare or unpredictable outlier, but a condition where early optimisation can stabilise lung function, reduce exacerbations, and prevent irreversible damage.^1,13

Yet in reality, patients can wait more than four years from referral before receiving the treatment that is right for them.¹⁴ Those lost years matter. Lung function declines. Steroid exposure accumulates. Quality of life deteriorates — often permanently.^12,15

The true cost of delay

Delayed intervention in severe asthma carries a high and largely hidden price tag. Complications linked to long-term corticosteroid use alone generate over €1 billion annually in additional healthcare costs across Europe — spending that reflects failure, not necessity.³

The societal impact is just as stark. Uncontrolled severe asthma reduces workforce participation and drives long-term productivity losses.³ Ensuring timely access to appropriate treatment could deliver up to £2 billion in productivity gains over 15 years.^1,3

There is also an environmental dimension. Poorly controlled asthma leads to more emergency visits, hospital admissions, and higher medication use — all of which increases healthcare-related carbon emissions.¹⁶

Learning from other diseases

Other specialties have already shown what is possible when timing becomes a core principle of care. In rheumatology, early targeted treatment has transformed mobility.¹⁷ In heart failure, early optimisation has reduced hospitalisation and mortality.⁶ In chronic kidney disease, timely intervention slows progression and avoids intensive care.⁷

Ensuring timely access to appropriate treatment could deliver up to £2 billion in productivity gains over 15 years.

The common thread is urgency. Time-bound pathways change trajectories. Severe asthma should be no exception.

Rebuilding care pathways around time

Transforming severe asthma care requires a shift from a fail-first mindset to a proactive disease-control framework. Early referrals must become routine, supported by simple criteria in primary care that trigger specialist assessment before irreversible harm occurs.¹¹

Once referred, care should be goal-oriented, with defined targets, regular review, and rapid escalation when control is not achieved.

A policy opportunity hiding in plain sight

Earlier intervention in severe asthma reduces avoidable healthcare use, lowers steroid-related harm, improves quality of life, supports workforce participation, and aligns with sustainability goals.³ The tools already exist.

The evidence is clear. Expert consensus is in place. What remains is the political will to move from agreement to action.

Document ID: Z4‑82548 | Date of preparation: April 2024

References

1. Couillard S, Lugogo N, Winders T, Bhutani M, Bates L, Robinson E, Evans A, Patel S, Gibson D, Price D. Modelling the impact of earlier biologic initiation in severe asthma patients. Poster presented at: European Respiratory Society (ERS) Congress; March 2025; London, UK.
2. Asthma UK. Slipping through the net: the reality facing patients with difficult and severe asthma. Available at: https://www.asthmaandlung.org.uk/sites/default/files/2023-03/auk-severe-asthma-gh-final.pdf. Accessed July 2025.
3. Bourdin A, Taube C, Dominguez-Ortega J, et al. Modelling the healthcare burden of oral corticosteroid use in France, Spain, and Germany. Revue Française d’Allergologie. 2025;65:104372.
4. Mayers I, Randhawa AK, Qian C, et al. Rate of admission and readmission to the ED among patients with severe asthma. Abstract presented at: European Respiratory Society (ERS) Congress 2024. European Respiratory Journal. 2024;64(Suppl 68):OA4584. doi:10.1183/13993003.congress-2024.OA4584.
5. NHS England. National cancer waiting times monitoring dataset guidance. Version 12.1. London, UK; NHS England; 2025. Published April 8, 2025. Updated April 9, 2025. Accessed January 28, 2026.
6. Upadhya B, Hegde S, Tannu M, Stacey RB, Kalogeropoulos A, Schocken DD. Preventing new‑onset heart failure: intervening at stage A. American Journal of Preventive Cardiology. 2023;16:100609. doi:10.1016/j.ajpc.2023.100609.
7. Kushner P, Khunti K, Cebrián A, Deed G. Early identification and management of chronic kidney disease: a narrative review of the crucial role of primary care practitioners. Advances in Therapy. 2024;41:3757–3770. doi:10.1007/s12325-024-02957-z.
8. Haughney J, et al. Global quality standard for identification and management of severe asthma. Advances in Therapy. 2020;37:3645-3659.
9. Scelo G, Torres-Duque CA, Maspero J, et al. Analysis of comorbidities and multimorbidity in adult patients in the International Severe Asthma Registry. Annals of Allergy, Asthma & Immunology. 2024;132(1):42-53.
10. Urrutia I, Resler G. How real patients with severe asthma experience their disease: An ethnographic study. Atención Primaria Práctica. 2020;2(4-5).
11. Global Initiative for Asthma (GINA). GINA Severe Asthma Guide 2024. Fontana, WI, USA: Global Initiative for Asthma; 2024. Available at: https://ginasthma.org/wp-content/uploads/2024/11/GINA-Severe-Asthma-Guide-2024-WEB-WMS.pdf. Accessed February 13, 2026.
12. Bhutani M, Winders T, Price D, et al. A time‑clocked care pathway on severe asthma: a global consensus by Delphi methodology. Abstract presented at: European Respiratory Society Congress; 2025. European Respiratory Journal. 2025;66(Suppl 69):PA1414. doi:10.1183/13993003.congress-2025.PA1414.
13. Stanley B, Chapaneri J, Khezrian M, et al. Predicting risk of morbidities associated with oral corticosteroid prescription for asthma. Pragmatic and Observational Research. 2025;16:95–109. doi:10.2147/POR.S484146.
14. Price D, Blakey J, Busby J, Chung LP, Hew M, Hu N, et al. Time from initial referral for specialist care until biologic therapy prescription for patients with severe uncontrolled asthma. Abstract presented at: European Respiratory Society (ERS) Congress; 2025. European Respiratory Journal. 2025;66(Suppl 69).
15. Menzies-Gow A et al. A renewed charter: key principles to improve patient care in severe asthma. Advances in Therapy. 2022;39(12):5307–5326. doi:10.1007/s12325-022-02340-w.
16. Wilkinson A, Khezrian M, Heaney LG, et al. Greenhouse gas emissions associated with severe asthma care in the United Kingdom. The Journal of Allergy and Clinical Immunology: In Practice. 2025;13.
17. Fadi NF. Efficacy of biologics in early vs. established rheumatoid arthritis. International Journal of Clinical Rheumatology. 2024;19(8):194-197. doi:10.37532/1758-4272.2024.19(8).194-197.

Disclaimer

POLITICAL ADVERTISEMENT

• The sponsor is AstraZeneca PLC, 1 Francis Crick Avenue, Cambridge, CB2 0AA, United Kingdom.
• The political advertisement is linked to advocacy regarding global approaches to asthma care.

More information here.