Asthma care in a specialist centre

Specialist asthma centres can improve patient outcomes for people with severe asthma

If you’ve been referred to a specialist asthma centre it’s because your GP or local hospital consultant believes you need more focused attention from a team of respiratory experts to get on top of your asthma symptoms, reduce your risk of asthma attacks and improve your quality of life. At a specialist asthma centre you’ll benefit from the full range of asthma tests, and be assessed for specialist treatments tailored to your specific type of asthma.

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What are specialist asthma care centres?

Specialist asthma care centres are known as ‘tertiary’ centres and are described as offering ‘tertiary’ care.

Most people with asthma manage their asthma well in ‘primary’ care – with support from their GP or asthma nurse at their local GP surgery.

Those who don’t are often referred to a respiratory specialist based in a hospital (secondary care).

A few go on to be referred to specialist asthma care centres for extra support in getting on top of their asthma symptoms (tertiary care).

For a centre to be called a specialist centre it needs to have access to all the specialists and tests needed, and to be led by at least two consultant respiratory physicians with a specific interest in severe asthma.

Where is my nearest specialist asthma centre?

If you’re referred to one of the specialist asthma centres around the UK it will be to the one that’s easiest for you to get to. But the number of centres in any one area varies across different regions with some regions having several asthma centres, and others only one. Usually a specialist asthma centre has a large catchment area. Each UK country also has a different approach to specialist care – some areas such as Wales do not have a specialist centre for example, it has networks of clinicians that may refer people to services in England.

This is one of the reasons that of the 250,000 people living with severe asthma symptoms in the UK only about 1,000 access this level of specialist care, with most either seeing a consultant in their local hospital, or relying on their local GP.

“Although the asthma clinic is a 150-mile round trip every fortnight it’s worth it; after only one year of treatment there, my asthma attacks have gone down to twice a year and when I do get admitted to hospital it is usually for a fortnight max.” Nichola Duane, aged 39, diagnosed with severe asthma in her twenties.

What do specialist asthma centres do?

The team of specialist consultants in a specialist centre offer an in-depth assessment of your asthma diagnosis, and a personalised review of treatment options.

Specialist asthma centres aim to:

  • confirm your asthma diagnosis and the type of asthma you have
  • identify any work-related asthma triggers
  • diagnose any other conditions that might be giving you asthma-like symptoms
  • diagnose and treat any conditions you have alongside your asthma that could be making your symptoms harder to manage
  • treat any conditions linked to your severe asthma, such as sleep apnoea
  • help you find ways to make the most of your medicines if you’re having trouble sticking to a routine
  • help you with any side effects
  • look at ways to help you avoid long-term use of high dose oral steroids
  • provide access to specialist treatments for people that could benefit from them
  • make sure you’re doing everything possible to cut your risk of asthma attacks, and reduce the need for hospital stays, including sticking to the medicines you’ve been prescribed.

“My consultant at the chest and allergy clinic is really supportive. They’ve changed my treatment plans and I’m finally on the right medication which is making my asthma easier to manage. My consultant also keeps my GP informed. I’ve recently had problems with my sinuses again which is flaring up my asthma, but my consultants are being really good and I am having appointments regularly to find out what’s going on.”
Celena Dell, aged 34, diagnosed with severe asthma aged 32.

Will I be offered specialist treatments?

Specialist medicines and treatments for severe asthma such as Xolair and Bronchial Thermoplasty are only prescribed after a full assessment to make sure they are relevant, and that you’re most likely to get the benefits from them.

How much time will I get at the specialist centre?

When you’re first referred to a specialist asthma centre you may be offered appointments across one or two days.

If you’re given a two-day appointment the first day will be all about reviewing your asthma, in detail, right from the start. This might make you feel like you’re repeating yourself, but it is an important first step, and will give the specialist consultants useful information about your asthma. You might be offered blood tests to check you’re taking your medicines in the right way, and skin prick tests to confirm any allergies.

On the second day you’ll be reviewed by a team of respiratory specialists which may include allergists, physiotherapists, and health psychologists. You may be offered more tests, such as a measurement of your airway inflammation.

You can make the most of your appointment by making sure you’re fully prepared and are ready to talk about your asthma in detail. 

What happens next?

Once your asthma has been fully reviewed across these two days the team at the specialist centre will recommend one of the following:

  • you’re able to return to your GP for continuing support in managing your asthma
  • you’re referred to a local consultant for support in continuing to manage difficult symptoms, but you don’t have severe asthma
  • you remain attached to the centre, with regular reviews, so that you can continue to access the specialist support you need for severe asthma symptoms, for ongoing treatment for other conditions, and for any side effects.

However, only a very small percentage of people access ongoing care at a specialist asthma centre – once your asthma is stable, you're likely to be referred back to your local hospital or GP.

How long will you be under the care of a specialist centre?

If you’ve been told you need to stay attached to the specialist asthma centre this is usually because you have severe asthma which needs long-term specialist care. If you’ve had an asthma attack that meant you needed intensive care your specialist consultants might recommend that you benefit from specialist asthma care indefinitely.

There may be a time when your specialist team feels you can manage your asthma well under the care of a consultant in the local hospital, instead of at the specialist asthma centre; or even with support from your GP, particularly if:

  • it looks as if your asthma symptoms can be managed by making sure you follow an updated asthma action plan and take your prescribed asthma medicines regularly
  • you’re able to manage another condition better that was making symptoms worse before
  • you’ve identified specific asthma triggers that you can avoid.

Who gets access to asthma care in a specialist asthma centre?

At the moment very few people access this level of care. There are only a small number of specialist asthma centres spread out across the UK, with large catchment areas. Those who do access it need to meet a set of criteria for example how many times you’ve had a life-threatening asthma attack and what dose of steroids you’re taking and how long you’ve needed them.

Once the centre receives a referral from your consultant or your GP they will assess it to see that care in a specialist asthma centre is right for you.

Last updated September 2016

Next review due September 2019