Asthma care in a specialist centre

Specialist asthma centres can help people with severe asthma

What are specialist asthma centres?

For a centre to be called a specialist asthma 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.

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. This is to help you 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.

Specialist asthma centres are known as tertiary centres and are described as offering tertiary care. Tertiary care is the third level of care, after primary and secondary care.

  • Most people with asthma manage their asthma well in primary care, with support from their GP or asthma nurse at the local GP surgery.
  • Some people who are not managing their asthma well are referred to a respiratory specialist based in a hospital. This is 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. This is tertiary care.

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

At the moment very few people access tertiary care in a specialist asthma centre. There are only a small number of specialist asthma centres across the UK, with large catchment areas. 

To access a specialist asthma centre or clinic you usually have to meet a set of criteria.

This may be related to:

  • how many asthma flare-ups or asthma attacks you’ve had
  • whether you’ve had a particularly bad asthma attack
  • the amount of medicines you need to stay in control of your asthma, including high-dose inhaled steroids or regular oral steroids.

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

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, and others only one. Usually a specialist asthma centre has a large catchment area.

Ask your GP where your nearest specialist care centre is. You may be able to claim back on travel costs to the centre. Find out more from the NHS

Each UK country also has a different approach to specialist care. Wales, for example, doesn't have specialist centres. Instead it has networks of clinicians that may refer people to services in England.

This is one of the reasons that of the 200,000 people living with severe asthma symptoms in the UK, only a very small percentage of people access ongoing care at a specialist asthma centre.

What do specialist asthma centres do?

The team of specialist consultants in a specialist asthma centre offers 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 that could be making your asthma 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 such as 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 if you could benefit from them
  • make sure you’re doing everything possible to cut your risk of asthma attacks, and the need for hospital stays, including sticking to the medicines you’ve been prescribed.

Will I be offered specialist treatments?

Specialist medicines and treatments for severe asthma such as monoclonal antibodies (MABS, also known as biologics) and bronchial thermoplasty are only prescribed after a full assessment to make sure you’re most likely to get the benefits from them.

How much time will I get at the specialist asthma centre?

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

Here's what might happen over a typical two-day appointment: 

  • The first day will probably be all about reviewing your asthma, in detail, right from the start. This may make you feel like you’re repeating yourself, but it's an important first step, and will give the specialist consultants useful information about your asthma. You may 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 may be reviewed by a team of respiratory specialists which could include 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 either:

  • make a plan so your asthma can be looked after by your GP or local hospital team. This doesn't prevent you being referred again in future if your asthma doesn't improve or if it gets worse again.
  • recommend that you stay under the care of the specialist centre. This means you'll have 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. If you’re prescribed a MAB you’ll stay under the care of the specialist asthma centre even if your asthma becomes stable.

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

If you’ve been told you need to stay under the care of the specialist asthma centre this is usually because you have severe asthma. If you’ve had an asthma attack that meant you needed intensive care, your specialist consultants may 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 your local hospital, instead of at the specialist asthma centre, or with support from your GP.

This is likely to be because: 

  • 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 managing another condition better so it's not impacting on your asthma so much. 
  • you’ve identified specific asthma triggers that you can avoid.

 

Last updated January 2020

Next review due January 2023