Abstract
Introduction
Uncontrolled asthma greatly affects quality of life globally and highlights unmet medical needs. Despite advances in treatment and care, many patients still experience delayed diagnoses, poor symptom control, and a reliance on emergency care. The Global Allergy and Airways Patient Platform (GAAPP) surveyed patients with moderate-to-severe uncontrolled asthma to assess their care experiences.
Methods
The GAAPP Time Clock Survey is a cross-sectional, online, multilingual survey of adults living in Brazil, Germany, Italy, Japan, Saudi Arabia, the United Arab Emirates, and the US. The survey examined diagnosis, symptoms, treatment outcomes, challenges in self-management, and timelines for care coordination.
Results
A total of 1401 individuals with self-reported asthma using combination inhaler therapy and experiencing symptoms were enrolled in this study. Among these participants, 56% reported waiting more than 1 month to undergo pulmonary function testing for diagnosis. Additionally, 51% indicated minimal to no improvement in quality of life despite treatment interventions. Difficulties in asthma management were reported by 42% of participants, with some describing the process as difficult or very difficult. Approximately 32% of individuals used daily corticosteroids. Nearly half of the cohort consulted three or more healthcare providers in their pursuit of effective asthma management. Emergency department visits were common, with 50% seeking urgent care for uncontrolled symptoms and 35% requiring hospitalization.
Conclusion
This study underscores the importance of policy reforms that prioritize timely diagnosis, shared decision-making, and long-term disease control. Improving outcomes for patients with uncontrolled asthma will require both clinical innovation and structural transformation.
Supplementary Information
The online version contains supplementary material available at 10.1007/s12325-025-03346-w.
Keywords: Uncontrolled asthma, Moderate-to-severe asthma, GINA step 3, Biologic therapies, Global patient survey, Asthma diagnosis delays, Multidisciplinary asthma care, Asthma management barriers
Key Summary Points
| Participants were identified based on self-reported asthma with daily use of inhaled corticosteroids and long-acting bronchodilators, reflecting GINA step 3 or higher treatment, to ensure alignment with moderate-to-severe uncontrolled asthma definitions |
| Despite meeting guideline-based criteria for advanced therapies, 56% of participants reported delays of ≥ 1 month in receiving lung function testing, and only 11% were receiving biologic treatment, underscoring persistent global gaps in timely diagnosis and access to care |
| Barriers to biologic therapy—including administration challenges, cost concerns, and needle aversion—were commonly reported, highlighting the urgent need for health system reforms that support earlier intervention, multidisciplinary care models, and equitable access to effective asthma management |
| These findings underscore the urgent need for multidisciplinary care models, timely diagnostic protocols, expanded access to biologics, and policy reforms to reduce global disparities in asthma care |
| This study was conducted to characterize the lived experiences of individuals with uncontrolled asthma systematically and to generate patient-centered evidence that can inform equitable policies, optimize care pathways, and reduce the global burden of this condition. |
Introduction
Asthma is one of the most common chronic respiratory conditions worldwide, but for millions living with moderate-to-severe forms of the disease, achieving effective control often remains a significant challenge, frequently requiring prolonged periods to attain [1, 2]. The global asthma epidemic transcends demographics, affecting individuals across all age groups, races, and ethnicities [3]. These realities starkly contrast the patient-centered goals outlined in the Global Initiative for Asthma (GINA) strategy, which prioritizes reducing day-to-day symptoms, improving lung function, and minimizing future risk, such as exacerbations, medication side effects, and long-term disease progression [4].
The Global Allergy and Airways Patient Platform (GAAPP), an international, patient-led nonprofit organization dedicated to advocating for individuals with atopic, allergic, and respiratory diseases, conducted a multinational survey to generate meaningful insights into the lived experiences of people with moderate-to-severe uncontrolled asthma. This effort aimed to inform more equitable, effective, and patient-centered approaches to asthma care across the globe. By capturing patient perspectives across diverse regions, this initiative seeks to support healthcare systems, providers, and policymakers in reducing the burden of uncontrolled asthma and enhancing quality of life for those affected.
Methods
The GAAPP Time Clock Survey was initiated on March 7, 2025. This survey method is a structured, retrospective, patient-reported tool developed by GAAPP to document the time intervals between key clinical milestones. This approach builds on validated concepts from patient journey mapping and retrospective timeline methodologies used in health services research to identify delays and gaps in care. GAAPP adopted this approach to quantify real-world diagnostic and treatment delays from the patient perspective across diverse international healthcare systems. This method is particularly appropriate in chronic conditions like asthma, where access, symptom recognition, and time to specialist care vary widely and are central to improving outcomes.
This cross-sectional survey assessed the experiences, challenges, and treatment pathways of individuals living with moderate-to-severe asthma based on patient reports. The survey was written in English and translated into Portuguese, Arabic, Japanese, German, and Italian by SurveyMonkey (SurveyMonkey Inc, San Mateo, CA). Survey questions were pretested by three of the authors, and native speakers tested the translated versions.
The US-based research team received an exemption for the English version of the survey, recruitment text, images, and consent form from a central institutional review board (BRANY, Lake Success, NY). No incentives were provided for survey participation. The study adhered to the ethical principles outlined in the Declaration of Helsinki and followed the Consensus-Based Checklist for Reporting of Survey Studies (CROSS) [5]. The survey was administered electronically and included a mix of multiple-choice, Likert scale, and open-ended questions to gather both quantitative and qualitative data. Descriptive analysis was used to identify patterns in patient experiences, regional differences, and emerging trends in asthma management.
Recruitment within the seven participating countries was conducted through patient advocacy groups and various online platforms, including the GAAPP Newsletter, Instagram, Facebook, X, LinkedIn, and Survey Monkey Audience. This approach aimed to ensure a diverse and globally representative sample, allowing for a nuanced understanding of patient experiences across different age groups and international healthcare contexts. To prevent multiple responses, the survey link was restricted to one use per IP address.
The inclusion criteria included: ≥ 18 years old, self-reported diagnosis of asthma, use of a daily combination inhaler therapy (inhaled corticosteroid and long-acting bronchodilator) indicating they are at least on GINA Step 3 or higher, presence of uncontrolled asthma symptoms, residing in one of seven countries (Brazil, Germany, Italy, Japan, Saudi Arabia, United Arab Emirates, or the US), and able to complete the online survey (in English or the translated version of Portuguese, Arabic, Japanese, German, or Italian).
All participants provided electronic consent prior to beginning the survey, during which the study’s purpose, procedures, and other relevant details were clearly explained. Participation was voluntary, with the option to withdraw any time. No personal data were collected, and responses were anonymized to protect privacy. Participants answered 28 questions about their healthcare interactions, use of medication (including biologics), barriers to treatment adherence, and preferences for new treatment options. The average survey response time was 4 min and 29 s (including 3551 screened respondents). The survey also gathered demographic data and explored past participation in clinical trials.
Results
A total of 1041 eligible adult participants were recruited from Brazil, Germany, Italy, Japan, Saudi Arabia, the United Arab Emirates, and the US (Fig. 1), reporting a diagnosis of asthma and using daily combination therapy of an inhaled corticosteroid (ICS) and a long-acting bronchodilator (LABA). Table 1 shows a percentage breakdown of each country’s participants for (A) age distribution, (B) gender, (C) related emergency room visit, hospitalization, use of oral corticosteroids (OCSs) for asthma exacerbation, (D) additional daily inhaler medication (100% of participants were on a ICS/LABA combination), rescue inhaler when needed, corticosteroid tablets/pills, different types of tablets/pills, biologic drugs, nebulized medications, and natural/alternative medicines.
Fig. 1.
Participant Distribution by Country Geographic distribution of the survey population (N = 1401) across seven participating countries
Table 1.
Country level: demographic characteristics of survey respondents (N = 1401)
| A. Age distribution | |||||||
|---|---|---|---|---|---|---|---|
| Country | 18–24 years | 25–34 years | 35–44 years | 45–54 years | 55–64 years | > 65 years | Total |
| Brazil | 22 (10%) | 89 (40%) | 74 (33%) | 23 (10%) | 8 (4%) | 4 (2%) | 222 (16%) |
| Germany | 39 (23%) | 58 (34%) | 48 (28%) | 9 (5%) | 11 (6%) | 7 (4%) | 172 (12%) |
| Italy | 27 (13%) | 53 (26%) | 48 (24%) | 47 (23%) | 22 (11%) | 5 (2%) | 202 (14%) |
| Japan | 8 (9%) | 8 (9%) | 31 (35%) | 15 (17%) | 19 (21%) | 7 (8%) | 89 (6%) |
| Saudi Arabia | 7 (8%) | 39 (44%) | 32 (38%) | 5 (6%) | 2 (2%) | 0 (0%) | 85 (6%) |
| United Arab Emirates | 6 (11%) | 23 (42%) | 19 (34%) | 3 (5%) | 3 (5%) | 1 (2%) | 55 (4%) |
| US | 62 (11%) | 119 (21%) | 140 (24%) | 125 (22%) | 83 (14%) | 42 (7%) | 576 (41%) |
| Total | 171 (12%) | 389 (28%) | 392 (28%) | 227 (16%) | 148 (11%) | 66 (5%) | 1401 |
| B. Gender of participants | |||||
|---|---|---|---|---|---|
| Country | Males | Females | Non-binary | No answer | Total |
| Brazil | 96 (43%) | 122 (55%) | 3 (1%) | 1 (0.4%) | 222 (16%) |
| Germany | 98 (57%) | 74 (43%) | 0 (0%) | 0 (0%) | 172 (12%) |
| Italy | 101 (50%) | 96 (48%) | 5 (2%) | 0 (0%) | 202 (14%) |
| Japan | 58 (65%) | 27 (30%) | 2 (2%) | 2 (2%) | 89 (6%) |
| Saudi Arabia | 43 (51%) | 42 (49%) | 0 (0%) | 0 (0%) | 85 (6%) |
| United Arab Emirates | 38 (69%) | 17 (31%) | 0 (0%) | 0 (0%) | 55 (4%) |
| US | 278 (48%) | 293 (51%) | 4 (1%) | 1 (0.2%) | 576 (41%) |
| Total | 712 (51%) | 671 (48%) | 14 (1%) | 4 (0.3%) | 1401 |
| C. Asthma-related emergency room visits, hospitalizations, and use of oral corticosteroids (OCS) | |||
|---|---|---|---|
| Country | ER visits | Hospitalizations | Taken OCSs for asthma worsening |
| Brazil | 151 (68%) | 69 (31%) | 96 (16%) |
| Germany | 63 (37%) | 66 (38%) | 40 (12%) |
| Italy | 84 (42%) | 53 (26%) | 62 (14%) |
| Japan | 25 (28%) | 39 (44%) | 37 (6%) |
| Saudi Arabia | 54 (64%) | 31 (36%) | 20 (6%) |
| United Arab Emirates | 25 (45%) | 24 (44%) | 21 (4%) |
| US | 293 (51%) | 219 (38%) | 225 (39%) |
| Total | 695 (50%) | 501 (36%) | 501 (36%) |
| D. Participants’ current asthma medications (in addition to daily ICS/LABA) | |||||||
|---|---|---|---|---|---|---|---|
| Country | Daily inhaler | Rescue inhaler | OCS | Other pills/tablets | Biologics | Nebulizer | Natural/alternative |
| Brazil | 115 (52%) | 143 (64%) | 118 (53%) | 44 (20%) | 20 (9%) | 93 (42%) | 39 (18%) |
| Germany | 76 (44%) | 89 (52%) | 47 (27%) | 36 (21%) | 12 (7%) | 29 (17%) | 24 (14%) |
| Italy | 94 (47%) | 124 (61%) | 51 (25%) | 36 (18%) | 12 (6%) | 56 (27%) | 16 (8%) |
| Japan | 32 (36%) | 42 (47%) | 29 (33%) | 21 (23%) | 12 (13%) | 8 (9%) | 4 (4%) |
| Saudi Arabia | 46 (54%) | 39 (46%) | 30 (35%) | 22 (26%) | 7 (8%) | 19 (22%) | 21 (25%) |
| United Arab Emirates | 25 (45%) | 29 (52%) | 19 (35%) | 15 (27%) | 12 (22%) | 19 (35%) | 14 (25%) |
| US | 342 (60%) | 363 (63%) | 160 (28%) | 131 (23%) | 73 (13%) | 163 (28%) | 99 (17%) |
| Total | 730 (52%) | 829 (60%) | 454 (32%) | 305 (22%) | 148 (11%) | 387 (28%) | 217 (15%) |
The most commonly reported daily symptom (Fig. 2) among the total cohort was coughing, experienced by 32% of participants (443 of 1401), followed by 27% who experienced daily shortness of breath or air hunger (375 of 1401), 26% with daily mucus production (363 of 1401), 24% with daily wheezing (331 of 1401), 23% experiencing daily chest tightness (315 of 1401), and 20% needing a daily rescue inhaler (274 of 1401). Weekly symptom occurrences were most common for chest tightness, reported by 40% of participants (554 out of 1401). Thirty-six percent (496 of 1401) reported weekly coughing, 32% (443 of 1401) experienced weekly wheezing, 35% (476 of 1401) had shortness of breath, and 31% (430 of 1401) used a rescue inhaler weekly. Oral corticosteroids (OCS) were used daily by 32% (454 of 1401) of participants for disease management, highlighting a concerning dependence on systemic corticosteroids to control unmanageable symptoms. Among the represented countries, Brazil reported daily OCS use of 43% (96 of 222).
Fig. 2.
Respondents’ Symptom Report Self-reported frequency of common asthma symptoms, including cough, shortness of breath, mucus production, wheezing, chest tightness, and rescue inhaler use
Respondents reported that their uncontrolled asthma significantly affected multiple aspects of daily life (Fig. 3). A substantial 48% (249 “very much” and 469 “a lot;” 718 of 1401) indicated that asthma limited their participation in leisure activities, while 46% (217 “very much” and 431 “a lot;” 648 of 1401) reported disrupted sleep. Nearly 45% (218 “very much” and 410 “a lot;” 628 of 1401) said their asthma often led to hospital or emergency room visits. Over 40% (214 “very much” and 373 “a lot;” 587 of 1401) stated that asthma negatively impacted their mental health, including feelings of anxiety or depression. Daily responsibilities were often affected, with 38% of respondents reporting that asthma impacted their work or meeting goals (163 “very much” and 365 “a lot;” 528 of 1401), and 36% said it affected shopping or managing their home (166 “very much” and 337 “a lot;” 503 of 1401). Notably, 36% (168 “very much” and 339 “a lot;” 168 of 1401) reported that asthma consumed a lot of their time. Finally, 28% (139 “very much” and 247 “a lot;” 386 of 1401) participants reported frequent sexual difficulties, and 27% reported problems with their partner or close relationships (126 “very much” and 249 “a lot;” 375 of 1401).
Fig. 3.
Impact of Asthma on Quality of Life Reported effects of uncontrolled asthma on leisure activities, sleep, healthcare use, mental health, and daily responsibilities
The time needed to get a definitive diagnosis varied widely among the participants. Notably, 56% (790 of 1401) reported waiting a month or more before undergoing essential lung function tests to confirm the diagnosis after their initial doctor visit. Meanwhile, 44% (611 of 1402) were able to complete their lung function test within a month of their first consultation. General medicine and primary care doctors emerged as the predominant initial point of contact for diagnosis for the participants, accounting for 40% (556 of 1386) of cases. Pulmonologists (26%; 360 of 1386) and allergists (14%; 194 of 1386) were also instrumental in the diagnostic process, underscoring their significant contributions to confirming clinical diagnoses.
Many respondents indicated that they sought opinions from multiple healthcare providers before receiving effective treatment, underscoring a fragmented care pathway and delayed access to optimal treatment. Notably, 48% (676 of 1401) of surveyed participants reported interactions with three or more healthcare professionals in managing their asthma.
Overall, nearly 50% (695 of 1401) reported visiting the emergency department (ED) for asthma-related issues, with the highest rates in Brazil (68%; 151 of 222), Saudi Arabia (64%; 54 of 85), and the US (51%, 293 of 576). Hospitalizations due to asthma were reported by 36% (501 of 1401) individuals, with the highest frequency in Japan (44%; 39 of 89) and the United Arab Emirates (44%; 24 of 55).
When asked about the effectiveness of their current treatment plan in controlling daily symptoms, 6% (86 of 1388) of respondents reported no improvement, and 45% (624 of 1388) indicated only minor improvement. Furthermore, 42% (584 of 1401) found it difficult or very difficult to manage their asthma, highlighting significant barriers to disease control.
Though individuals in this study had uncontrolled symptoms on GINA guideline step 3 or higher care, only 11% (148 of 1401) reported using biologic therapies. Seventy percent of respondents reported a willingness to use a biologic if administered monthly (386 of 552), while 74% indicated they would prefer to receive a biologic in the future if it were available every 6 months (407 of 552).
The survey revealed frequent discontinuation of biologic therapies, often due to various factors. The main reasons included difficulties in fitting treatment into daily routines (37%; 206 of 850), challenges with using delivery devices (34%; 187 of 550), needle aversion (28%; 152 of 550), and concerns about the financial costs of treatment (28%; 152 of 550).
Discussion
This international survey underscores the persistent global gaps in timely diagnosis, treatment access, and coordinated care for patients with moderate-to-severe uncontrolled asthma, despite well-established clinical guidelines. While asthma management has evolved significantly over the past 2 decades, with the introduction of inhaled corticosteroid/long-acting bronchodilator combinations, precision biologics, and structured care pathways, our findings reveal that these advances have not yet translated into equitable improvements in outcomes for many patients. Delays in diagnosis, frequent reliance on emergency care, and underutilization of biologics remain common across the seven countries represented in this survey [6].
Historically, the underdiagnosis and mismanagement of asthma have been well documented, especially in primary care settings where diagnostic tools such as spirometry are underutilized [1–3, 7]. GINA guidelines have long emphasized the importance of objective pulmonary function testing in confirming an asthma diagnosis, ideally performed as soon as possible after symptom onset [4]. However, our data show that more than half of patients waited ≥ 1 month for lung function testing, a delay comparable to an earlier international survey from the early 2010s [8]. These delays further increase the risk of exacerbations and misdiagnoses. Additionally, they risk leading to inappropriate treatment escalation that does not follow current guidelines [4]. Our data show that 32% of respondents still rely on the daily use of OCSs.
Although educational initiatives and disease awareness campaigns have proliferated over the past 5–10 years, patients continue to report high reliance on acute care. Remarkably, this study showed a continued reliance on emergency care, with 50% of respondents visiting the ED and 36% requiring hospitalization for asthma-related events. These findings mirror patterns observed in past research and signal a global failure to shift asthma care from reactive to preventive [9].
There have been meaningful scientific advances in asthma pharmacotherapy over the past decade, most notably with the emergence of biologic agents targeting IgE, IL-5, IL-4/13, and TSLP pathways. These therapies have demonstrated significant clinical benefits in reducing exacerbations, improving lung function, and reducing reliance on systemic corticosteroids. Our study shows that only 11% of respondents who meet guideline criteria for biologic use are actually receiving them, echoing previous real-world analyses on the underuse of biologics [8, 10, 11].
This study presents an updated patient perspective on known obstacles to treatment adherence and biologic therapy [8, 11]. Common patient-level barriers included difficulties integrating treatment into daily life, issues with device use, and cost, which often led to discontinuation. This underscores the continued importance of offering simpler administration methods, providing patient-focused education, and enhancing shared decision-making to promote sustained adherence.
Improvements in asthma outcomes are possible, as demonstrated by specific regional and health system successes. Countries with integrated care models, widespread spirometry access, and comprehensive biologic coverage have reported improved control rates and reduced hospitalizations [12, 13]. However, these improvements are not evenly distributed and are often absent in low-resource settings or among socially disadvantaged populations, reinforcing the need for globally scalable, equity-focused interventions. As shown in Table 2, gaps in diagnostic access are particularly evident in Brazil and Saudi Arabia, where spirometry may not be routinely available in primary care. In contrast, countries like Germany and the US may benefit more from efforts to reduce diagnostic redundancies and improve coordination between primary and specialty care providers. Country-specific adaptations, such as mobile health delivery in the UAE or telemedicine expansion in Japan, highlight scalable strategies to improve treatment continuity.
Table 2.
Country-specific healthcare system and asthma management features
| Country | Healthcare system characteristics | Care model adaptations | Gaps in asthma management | How multidisciplinary care can address gaps |
|---|---|---|---|---|
| US | Advanced healthcare system with access to specialists, diagnostics, and medications | Integrated care teams including allergists, pulmonologists, nurse practitioners, physician assistants, asthma nurses, pharmacists, and clinical psychologists | Fragmented care, treatment adherence, socioeconomic disparities, underutilization of biologics |
Improve care coordination across specialists (e.g., PCPs, allergists, pulmonologists, nurse practitioners, physician assistants, and asthma nurses) Expand patient education programs on asthma self-management and medication adherence Address socioeconomic barriers through policy and care coordinators |
| Brazil | Mixed healthcare system with both public and private care, with disparities in access to services | Care models with limited involvement of specialists, reliance on general practitioners | Delayed diagnosis, high reliance on oral corticosteroids, lack of education on biologics |
Introduce multidisciplinary care models in primary care settings Train GPs to recognize early asthma symptoms and initiate guideline-based treatments Expand access to biologic therapies and ensure cost reduction strategies |
| Italy | Universal healthcare system; asthma care can vary between regions, with some areas having better access to specialists and diagnostic tools than others | Coordinated care models with allergists, pulmonologists, primary care providers, pharmacists, and asthma educators | Inconsistent care delivery across regions, delays in access to advanced therapies |
Strengthen collaboration between regional care providers Improve access to biologics, particularly in rural areas Implement mobile health solutions to improve care in remote locations |
| Germany | Well-established healthcare system with quality asthma management resources | Care models involving specialists, asthma nurses, dietitians, and psychologists | Inequities in care access, especially in rural areas |
Establish telehealth programs to bridge gaps in rural access Focus on reducing reliance on systemic corticosteroids by integrating pharmacists for medication counseling and monitoring |
| Japan | Highly developed healthcare system with a focus on technology-driven solutions | Multidisciplinary teams with allergists, pulmonologists, allergists, and asthma educators | Access challenges in rural areas, underuse of preventive therapies |
Increase asthma awareness and education in rural areas Expand telemedicine services for asthma management Promote early diagnosis and preventive treatment adherence |
| Saudi Arabia | Emerging healthcare system with growing access to specialists and advanced treatments | Specialized care with allergists, pulmonologists and asthma nurses in urban centers | Fragmented care, delayed diagnosis, underuse of inhalers in rural areas |
Train primary care providers to improve early diagnosis Expand access to medications and biologics in rural areas Improve patient education on asthma management and inhaler use |
| United Arab Emirates | Advanced healthcare system with access to specialists and a focus on innovation | Integrated care teams with allergists, pulmonologists, asthma nurses, and dietitians | Limited access in remote areas, challenges with treatment adherence |
Develop mobile health services to reach remote populations Strengthen asthma management training for primary care providers Increase access to biologics and advanced therapies |
Poor access to routine care, lack of action plans, and fragmented care coordination contribute to this ongoing cycle. To break this pattern, Table 3 emphasizes policy strategies such as national asthma self-management programs, standardized emergency department protocols, and shared electronic health records to reduce redundant care and promote continuity. Taken together, these study findings reinforce that improving asthma outcomes requires not only adherence to treatment guidelines but also systemic investments in infrastructure, education, and policy reform. Health systems must implement multidisciplinary care models, integrate primary and specialty care, and create incentives for early intervention. Policy leaders should address socioeconomic disparities, promote patient empowerment, and ensure that innovation in asthma treatment reaches the populations who need it most.
Table 3.
Policy recommendations
| Policy area | Policy recommendation | Impact on asthma care and patient outcomes |
|---|---|---|
| Timely diagnosis and treatment | Establish national standards for early diagnosis | Reduce diagnostic delays and ensure timely access to pulmonary testing |
| Access to specialized care | Reduce diagnostic delays | Expedite the diagnosis process, allowing earlier initiation of effective treatments |
| Enhance access to pulmonologists and allergists in rural areas | Expand telemedicine services and mobile health units to bridge gaps in care for underserved regions | |
| Encourage multidisciplinary care in rural settings | Integrate nurse practitioners, asthma nurses, and care coordinators to manage asthma in primary care, ensuring continuous care | |
| Socioeconomic barriers | Reduce financial barriers to medications | Subsidize biologics and other treatments and improve insurance coverage for vulnerable populations |
| Social support programs | Provide care coordination services to help patients with medication access, appointments, and education | |
| Patient education and self-management | Implement national patient education campaigns | Educate patients on asthma management, proper inhaler use, recognizing triggers, and adherence to treatment regimens |
| Asthma self-management programs | Promote self-management programs integrated into primary care to help patients track symptoms and adhere to treatments | |
| Care coordination | Establish care coordination models | Formalize collaboration between primary care providers, pulmonologists, allergists, and asthma educators to improve care delivery |
| Shared electronic health records (EHR) | Enhance communication between healthcare providers, ensuring continuity of care and reducing unnecessary tests and referrals | |
| Access to biologics and advanced therapies | Ensure equitable access to biologics | Subsidize biologic treatments and ensure insurance coverage to provide biologics for eligible patients |
| Expand coverage of novel therapies | Facilitate coverage for advanced therapies in national health systems to reduce the cost barriers for patients | |
| Emergency care utilization | Strengthen primary care services to reduce emergency visits | Promote proactive asthma management, regular follow-ups, and early intervention to reduce emergency department visits and hospitalizations |
| Emergency department asthma protocols | Standardize asthma management protocols in emergency departments to ensure timely and effective care | |
| Global coordination and advocacy | Collaborative international guidelines | Create standardized asthma care guidelines across countries, reducing discrepancies and improving care consistency |
| Advocacy for asthma care improvements | Advocate for policies that prioritize asthma management, focusing on access to therapies, education, and coordinated care |
Although this study relies on self-reported data and GINA Step 3+ approximation, these limitations may introduce recall and selection bias. An additional limitation is that the Time Clock survey is not a validated instrument.
Conclusion
As healthcare systems strive to bridge the gap between asthma guidelines and real-world outcomes, this study provides real-time, valuable insights into patient experiences and identifies practical pathways for reform. It is critical to focus on developing and implementing key care policies to address the significant challenges faced by patients effectively. Essential areas for policy focus include the establishment of standardized protocols for prompt diagnosis, the integration of multidisciplinary care frameworks, the enhancement of access to biologic therapies, the incorporation of patient-centered initiatives, and the formulation of protocols ensuring rapid follow-up post-emergency department encounters. Prompt and decisive action in these domains is essential to mitigate existing care gaps and improve outcomes for this vulnerable patient cohort.
Supplementary Information
Below is the link to the electronic supplementary material.
Acknowledgements
GAAPP and the co-authors thank the participants of this study for their contributions.
Author Contributions
Karen Rance, Brenda Young, Gretchen McCreary, Stephanie Williams, Marilyn Urrutia-Pereira, Kristen Willard, Ghulam Mustafa, Purvi Parikh, Tonya Winders, and Ruth Tal-Singer all contributed to the conception and design of the study and participated in the drafting, critical revision, and approval of the final manuscript. All authors reviewed the final version of the manuscript and agree to be accountable for the accuracy and integrity of the work. Ruth Tal-Singer led the coordination of the survey. Karen Rance led the writing of the manuscript. Brenda Young is a patient author.
Funding
An unrestricted educational grant from AstraZeneca (95531573) funded this study and its publication who will also be paying the.
Data Availability
The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.
Declarations
Conflict of Interest
Karen Rance, Brenda Young, Gretchen McCreary, Stephanie Williams, Kristen Willard, and Ghulam Mustafa, as well as Marilyn Urrutia Pereira, have no disclosures to report. Purvi Parikh is a speaker for Genentech. Tonya Winders is a paid advisor and speaker for AstraZeneca, Chiesi, GSK, Novartis, Roche, and Sanofi Regeneron. Ruth Tal-Singer is a shareholder of GSK and holds share options in ENA Respiratory and reports personal fees from AstraZeneca, Boehringer Ingelheim, ENA Respiratory, Janssen, Roche, Vocalis Health, Teva, ImmunoMet, Renovion, Samay Health, GSK, ItayAndBeyond, COPD Foundation, and GlobalSkin.
Ethical Approval
The United States-based research team received an exemption for the English version of the survey, recruitment text, images, and consent form from a central institutional review board (BRANY, Lake Success, NY), granted an exempt determination for the English version of the survey, recruitment text, images. No incentives were provided for survey participation. The study adhered to the ethical principles outlined in the Declaration of Helsinki and followed the Consensus-Based Checklist for Reporting of Survey Studies (CROSS) [5]. The survey was administered electronically and included a mix of multiple-choice, Likert scale, and open-ended questions to gather both quantitative and qualitative data. All participants provided electronic consent prior to beginning the survey, during which the study’s purpose, procedures, and other relevant details were clearly explained. Participation was voluntary, with the option to withdraw any time.
Footnotes
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Supplementary Materials
Data Availability Statement
The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.