Summary
Aims
Biologics have been proven efficacious for patients with severe asthma (SA). It is essential to diagnose such individuals correctly. This study was designed to survey pulmonologists to identify barriers to early diagnosis and subsequent appropriate use of biologics for SA in Croatia.
Methods
A pulmonologist group with expertise in SA developed the initial list of questions, with the final questionnaire created according to a 2-round Delphi method. The resulting survey consisted of 23 items consequently divided into 4 domains: 1) Pulmonologists’ demographics and professional experiences; 2) Concerns about asthma management; 3) Attitudes toward SA diagnosis; and 4) Beliefs and attitudes regarding the use of biologics in managing SA. The given answers represented the respondents’ estimates.
Results
Eighty-four surveys were analyzed, with pulmonologists observing that general practitioners often inaccurately diagnose asthma and treat acute exacerbations. Although specialist centers are capably and correctly equipped, the time to diagnose patients with SA is approximately 3.5 months, with initial use of biologics delayed an additional 2 months. The primary indications for prescribing biologics are conventional therapy with oral glucocorticoids (91.7%) and frequent acute exacerbations (82.1%). In addition to improper diagnosis (64.3%), many patients with SA do not receive the indicated biologics owing to strict administrative directives for reimbursement (70.2%) or limited hospital resources (57.1%).
Limitations
The limitations of this survey include the subjective nature of the collected data, the relatively small sample size, and the lack of the biologic efficacy evaluation.
Conclusions
Croatian pulmonologists observed that a significant number of patients with SA who are eligible for biologics are not prescribed them, largely because of an inaccurate and/or delayed diagnosis, a delayed referral to a specialist center, highly restrictive criteria for reimbursement, and/or institutional budgetary limitations.

Relevance
This article is relevant because of important epidemiological data related to asthma. Furthermore, the article is due to the importance of early diagnosis and treatment with biological drugs in patients with severe asthma, as well as the importance of tracking symptoms of this chronic disease. However, according to the experiences of pulmonologists, the results showed that Croatian general practitioners rarely undertake diagnostic procedures for quantitative verification of asthma. This situation could be significantly improved by earlier identification of patients with asthma, the establishment of a referral system and standardization of referral routes, and minimizing the time required for identification. In addition to important epidemiological data, this work also provides important guidelines for the prevention and successful treatment of this chronic lung disease.