TABLE 1.

Key potential care gaps in asthma, obstructive sleep apnea (OSA) and chronic obstructive pulmonary disease (COPD)

Asthma	OSA	COPD
Health care practitioner- or system-driven care gaps
Inadequate assessment of asthma control	Under-recognition of OSA	Underuse of spirometry, resulting in underdiagnosis, inappropriate diagnosis
Failure to provide a written asthma action plan	Delayed diagnostic testing for OSA (in adults and children)	Low referral rates for pulmonary rehabilitation
Underuse of spirometry, resulting in overdiagnosis	Underreferral to sleep specialists for OSA management	Lack of access to a case manager and a self-management program
Failure to refer to a specialist when required	Lack of validated action plans for OSA treatment	Failure to offer influenza vaccination
Failure to provide asthma education	Undertreatment of OSA	Inappropriate therapeutic initiation and escalation
Failure to address smoking cessation	Inconsistent follow-up in OSA	Failure to address smoking cessation
Patient-driven care gaps
Insufficient understanding of asthma control criteria	Poor adherence to CPAP therapy	Poor adherence to treatment
Poor adherence to treatment		Poor adherence to pulmonary rehabilitation and exercise maintenance
Poor environmental control		Poor ability to recognize the signs and symptoms of an exacerbation
Non-use/misunderstanding of the asthma action plan

CPAP Continuous positive airway pressure