Uncontrolled asthma in Primary care in Singapore

<bold>Introduction:</bold> Asthma is a major chronic respiratory disease worldwide. Despite that, the prevalence of uncontrolled asthma in Singapore is under-studied. <bold>Objectives:</bold> To study the burden of uncontrolled asthma in NUHS primary care (polyclinics). NUHS is one of three major hospital clusters serving approximately 1.5 million population. <bold>Methods:</bold> To analyze data from NUHS polyclinics dating July 2022 to June 2023. <bold>Results:</bold> There were a total of 1668 urgent asthma visits by 1375 patients (111 episodes per 100,000 resident population). Of these, 165 (9.9%) visits were referred to Emergency departments (ED) for further treatment; 1503 (90.1%) visits improved with treatment at polyclinics and were discharged with an early appointment. Notably, 256 patients (18.6%) had uncontrolled asthma with 2 or more ED visits in the year. Out of these, 741 (53.9%) are female. 31.7% of them were 40 years old and younger, while 32.7% of them were between 40 and 60 years old. There is a disproportionately high number of patients of the Malay ethnic group (34.2%). 11.2% of these patients stayed in rental flats, signifying lower socioeconomic status. <bold>Conclusions:</bold> Asthma-related acute care utilization in Singapore is high. This is the first study describing uncontrolled asthma in primary care in Singapore. 20% of patients (100 episodes per 100,000) requiring urgent visits for asthma are managed in primary care without an ED visit. Out of these patients in primary care, 18.6% had uncontrolled asthma and 50% of them had defaulted their appointment and were likely non-adherent to asthma controllers. This may be linked to lower socioeconomic status and poorer health-seeking behavior. Further studies on interventions to improve patient adherence are required.