Enhancing severe asthma referral and care through Severe Asthma Network: the experience in Kota Setar, Kedah, Malaysia.

Suboptimal referral processes for suspected severe asthma can delay diagnosis and treatment. This registry-based descriptive study aimed to describe real-world observations from the Severe Asthma Network initiative in Kota Setar, Kedah, Malaysia on improving referral efficacy, diagnosis capabilities and treatment outcomes for severe asthma. Hospital Sultanah Bahiyah has received referrals from nearby district hospitals or health clinics between September 2023 to September 2024. Difficult-to-treat asthma patients were first assessed by physicians in their respective primary health clinics or district hospitals using the simplified and digitalized Severe Asthma Referral Form, adapted from the existing Severe Asthma Referral Checklist by the Malaysian Thoracic Society. Patients meeting any one of the four referral criteria in the checklist were referred. This initiative facilitated the referral for 58 patients, with 53 patients attending appointments at the severe asthma referral center. Median time taken from referral to first appointment is seven days, shorter than the usual waiting time of 30 days (p < 0.001). Five patients (9.4%) were eventually diagnosed with severe asthma; time to diagnosis ranging from 25 to 36 days for three patients, and 182 and 196 days for the other two. Among the 53 patients, 14 patients (26.4%) underwent treatment escalation. Significant improvements in mean Asthma Control Test scores for baseline vs. latest were observed (17.2 vs. 20.4; p = 0.009). The Kota Setar Severe Asthma Network has facilitated early referral of suspected severe asthma patients, showing early success in reducing waiting time while expediting severe asthma identification for optimized treatment outcome.