In addition to reviewing the tools, summit delegates considered the feasibility of adapting several success stories in their countries.

Three-step AIR Treatment Guideline in New Zealand13

In 2020, New Zealand national asthma guidelines, which had strong primary care involvement, recommended AIR therapy as the preferred management approach (Fig. 5). The guidelines were launched with a structured communication plan for wide distribution and encouragement for implementation in practice. A recently published evaluation of the impact of these guidelines identified a significant increase in the dispensing of ICS–formoterol and a reduction in the dispensing of SABA inhalers since the release of the recommendations14. This evidence suggests that widespread transition to AIR therapy regimens as recommended by GINA could be achieved if recommended in national asthma guidelines, jointly developed and endorsed as the preferred therapeutic approach by primary and secondary care, and supported by optimised systems for access to medicines and appropriate clinician reimbursement. It is also important to consider the patients’ preference as it will likely impact their adherence to the medication.

Fig. 5: 2020 New Zealand AIR therapy-based algorithm.

Reproduced with permission from: Asthma and Respiratory Foundation NZ, New Zealand Adolescent and Adult Asthma Guidelines 202013. AIR anti-inflammatory reliever.

Taking advantage of teachable moments in Spain

In Spain, community pharmacist capability and confidence have been improved through a Teach the Teacher®15 programme led by IPCRG-taught pharmacists and family physician teachers. This recognises the opportunity for community pharmacists when a SABA inhaler is requested over the counter to take advantage of the teachable moment that it might offer. Strong relationships among patients, family physicians and community pharmacists have been developed to change the asthma pathway, moving away from providing SABA canisters on demand over the counter in pharmacies to using Asthma Right Care tools with individuals, offering advice about right care and prompting those with poorly controlled asthma to visit their family physician for review16. This approach resulted in 500,000 fewer SABA canisters sold in 2020 compared with 2018.

Patient and public engagement in Portugal

In Portugal, creative bottom-up approaches to patient and public engagement have been used. To date, more than 50 organised walks and talks (‘Caminhasma’, meaning ‘walk with asthma’) planned by primary care physicians, nurses and community pharmacists involving almost 4000 people within their communities, have taken place to improve asthma literacy and awareness. Subsequently, the initiative has been replicated in Brazil. Also, the Asthma Right Care (known as ‘CAPA’) team has co-created a teaching film and delivered a series of television interviews for a health channel, as well as clinical webinars. A new campaign aimed at adolescents with a video promoting a game between the viewers to teach about asthma is being developed in partnership with the Ministry of Education of Portugal.

Draft national asthma law in Argentina

In Argentina, respiratory-interested clinicians have advocated to the national senate for an asthma law to allow equal access to care for every person with asthma. They have separately worked with colleagues in other specialities to raise awareness about specific at-risk groups such as pregnant women who, according to an unpublished national survey, often stop taking their asthma prescription during pregnancy.

Asthma lexicon in Tunisia

In Tunisia, a multidisciplinary Asthma Right Care steering group prioritised a SABA overuse awareness programme in community pharmacies supported by the Pharmacists Union and the Private Physicians Union. The programme was presented to the Minister of Health who encouraged the initiative. IPCRG’s tools, such as the Reliever Reliance Test and Asthma Slide Rule, were translated to Tunisian dialect to support the nationwide programme. The group also developed a lexicon of Tunisian dialect’s usual asthma and allergy words with their translation in French and English. This lexicon ensures that the terminology used in communication becomes more consistent across the healthcare system.

Many other success stories are emerging, demonstrating the value of bottom-up approaches that engage primary care and patients in highlighting the problem of episodic care and then taking responsibility to address it through education and advocacy for system change.

Nine statements to improve respiratory care

The delegates were shown and supported nine key actions to improve respiratory care that IPCRG and the World Organization of Family Doctors (WONCA) Europe agreed at the 2023 WONCA Council meeting (see Fig. 6).

Fig. 6: Nine statements agreed with the IPCRG and WONCA Europe to improve respiratory care.

IPCRG International Primary Care Respiratory Group, WONCA World Organization of Family Doctors.