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APP role in severe asthma care
Addressing Gaps in Severe Asthma Care With the Help of APPs

Released: October 31, 2025

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Key Takeaways
  • Asthma affects approximately 28 million Americans, and 5% to 10% have severe asthma.
  • It is critical for HCPs to stay up to date on the new and emerging therapies for severe asthma, especially as agents with new mechanisms of action become available.
  • APPs have a critical role in severe asthma care by bridging gaps and ensuring clear communication across the entire healthcare team.

Asthma is a common, chronic disease that affects approximately 28 million Americans and disproportionately affects women, Black people, and those with a lower socioeconomic status. Furthermore, approximately 5% to 10% of patients have severe asthma. In particular, approximately 40% of the patients seen in my clinic have severe or difficult-to-control asthma.

The burden of disease for patients with severe asthma is high, as there are many psychosocial and financial factors at play. Some patients cannot attend work because of the burden of their disease. In addition, treatment can be costly, and it is often distressing for those who visit the hospital or clinic frequently because of severe asthma attacks, as these patients may feel they cannot get good control of their disease. This is why it is critical to me, as a healthcare professional (HCP), to build a trusting relationship with my patients. I want them to feel like they can access a severe asthma specialist—someone who is competent in the management of severe asthma and keeps up to date on the available and emerging therapies for this disease.

Current Gaps in Severe Asthma Care
The greatest area of need I see for patients is access to care. If patients do not have an HCP who is comfortable and confident with managing severe asthma, then this is a gap that must be overcome. Another need is the use of appropriate treatment for severe asthma. Often, if HCPs do not fully understand how severe one’s asthma is, then patients may not be treated with the most appropriate therapy. Individuals who should be assessed for severe or difficult-to-control asthma include those who frequently visit the hospital, urgent care, or clinic because of their disease. The take-home message here is that patients should be connected with a specialist as soon as severe asthma is recognized.

Another piece of the puzzle is assessing and supporting patients’ environment. This is vital because, again, asthma disproportionately affects people with a lower socioeconomic status. Many of these patients are subjected to suboptimal housing conditions with lots of potentially harmful exposures, and this is an important part of asthma management. Regardless of the life-changing, advanced therapeutics that we have available, HCPs cannot forget that patients’ environment (ie, home, work, and geographic location) can contribute to poor disease control.

Treatment Considerations for Severe Asthma
HCPs who manage patients with severe asthma must be aware of both currently available and emerging treatments. Too frequently, patients will have tried multiple options that only worked for some time. Either the treatments seem to be ineffective or something changed with their asthma phenotype or endotype. In both cases, HCPs need to reconsider other therapies. This is why it is imperative that there are multiple treatment options available for patients with severe asthma and that the HCP is aware of these options.

Of note, asthma is a heterogeneous disease. Although there are different phenotypes of asthma, much of the available therapies target type 2 inflammation. And as newer therapies emerge, more options will become available for patients whose asthma does not fall into the type 2 phenotype. It is always helpful to keep up to date on the emerging therapies, so we can best serve patients in determining what is going to be the ideal targeted therapy for them down the line.

APP Role in Severe Asthma Care
Advanced practice providers (APPs) have a unique role in a severe asthma clinic. In my practice, 100% of my time is spent on chronic disease management for asthma and other airway diseases. My role essentially expands access to care as much as possible by managing a panel of patients in addition to seeing patients for urgent visits or to bridge the gap when the treating HCP is not available. For those who need more frequent follow-up, I always make myself available.

When I see patients and am helping to manage their severe asthma, an important part of my role in their care is to ensure I am communicating appropriately on what they need and what their wishes are to the treating HCP. I also help the treating HCP determine what the best therapy is for each patient, how to move forward, how to support patients best, and what else we can do to improve their care.

But comprehensive care does not stop with the APP. It is also important to provide interdisciplinary, team-based care to patients with severe asthma. Pharmacists, for example, are critical for asthma management because patients must be able to access and use their prescribed treatments, whether that includes inhaled devices, biologics, or nebulized therapies. Pharmacists have this helpful and unique role because they can have more frequent contact with patients. In doing so, pharmacists can ensure patients understand how to use their treatment, which helps us APPs and other treating HCPs who need to spend appointment time focused on reviewing disease course, imaging, and managing lab work for patients. Then there are others, of course, like nurses, social workers, and physical therapists for those patients who need extra support.

The APP serves as what I would call the focal touchpoint for many patients with severe asthma. Although we might be the ones seeing patients more frequently, we also must ensure there is good and clear communication with all team members involved in their care.

Your Thoughts
How confident are you in your ability to care for patients with severe asthma? You can get involved in the conversation by answering the poll question and posting a comment below.

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How confident are you in your ability to care for patients with severe asthma?

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