Five basic steps to world class asthma care

The National Institute for Health and Care Excellence (NICE) Quality Standard refocuses key priorities for asthma.

The Government’s NHS Long Term Plan set out the ambition to transform respiratory outcomes, including reducing asthma attacks and deaths, to equal or better than our international counterparts. But with the UK low in the European asthma mortality league, and 60% of people with asthma not getting “basic care”, what changes would move the UK up in the table? 

In this blog, Asthma UK clinical lead, Dr Andy Whittamore, explains why following the updated NICE Quality Standards should ensure people with asthma get the basic care they need. 

1. Objective tests to support diagnosis

Asthma is still commonly misdiagnosed, and people with untreated asthma are at risk of an asthma attack. I’m glad NICE are taking steps to address this issue by recommending objective tests, like Fractional exhaled nitric oxide (FeNO) and spirometry to support a diagnosis of asthma so that patients can start receiving the correct treatment for their asthma and be confident about why they are needing to take it.

However, at the moment many GPs don’t have access to the latest tests so at Asthma UK, we are calling for primary care providers and commissioners to implement diagnostic hubs. The NHS Long term plan promises to improve diagnosis for all respiratory conditions and we are pushing NHS England to make sure this happens.

2. Written Asthma Action Plans

I’m pleased to see written personalised action plans have been highlighted as one of the five quality statements now listed by NICE. People with an asthma action plan are four times less likely to be admitted to hospital because of their asthma, but most people don’t yet have one set up with their doctor or nurse. Action plans can help people to keep doing the things needed to keep their asthma under control. More importantly they can help people to recognise when their asthma is becoming less well controlled and what actions are needed to get their asthma back under control.

Asthma UK has developed free written asthma action plan templates for adults and children, and in a range of languages. The adult plan is also available on EMIS’s asthma template. I always encourage my patients to take a copy of their plan home with them to remind them how to monitor their asthma, and to share it with friends and family, as this could be lifesaving if they were to have an asthma attack.

3. Monitoring asthma control

Monitoring asthma control is a crucial element of both a patient’s and clinician’s understanding of an individual’s case of asthma. By asking about symptoms, reliever use and flare ups – especially if the flare up has required oral steroids – we are able to gather a better understanding of our patients’ condition. Using a questionnaire, like the Asthma Control Test, is a simple and effective way to make sure all the right questions are covered during a review and any warning signs are flagged. I also use the Asthma Slide Rule – a great tool for assessing how well controlled my patients’ asthma is on the basis of reliever inhaler use. 

4. GP follow up appointment 48 hours after emergency care

64% of people with asthma still aren’t receiving follow up appointments with their GP after an emergency episode (e.g. 999 call, visit to A&E or urgent care centre). People who have had an acute asthma attack are those most at risk of having another one. By reviewing them soon after a hospital attendance, clinicians are more likely to see them while they are receptive to the potential seriousness of asthma. Follow up appointments in the days after an attack are therefore crucial to: ensuring a patient is recovering well, preventing any further deterioration in a patient’s condition and optimising the management of a patient’s asthma to prevent any future exacerbations.

Additionally, Asthma UK is pushing for joined up data so that patients are automatically recalled to their GP after attending A&E.

5. Suspected difficult or severe asthma

With more treatments including biologics becoming available to people diagnosed with severe asthma, it is crucial that patients with difficult to control asthma are referred on to specialist clinics to gain access to these treatments. At present, many thousands of people with difficult asthma are “slipping through the net” without specialist care or access to new treatments. The NICE Quality Standard now states clearly that anyone who has had two or more courses of high-dose oral corticosteroids in a year should be referred for specialist diagnostics and multidisciplinary care. 

Making it happen 

Asthma UK supports the focus and emphasis the new NICE Standards give to these five steps of basic care. If we can understand the priorities for asthma patients, there is stronger likelihood of patients receiving the right basic care and moving the UK up the European asthma league.

If you’re looking for easy ways to improve the care you can give your patients with asthma, why not check out our great online features which offer social prescribing options for NHS teams and advice for people with asthma?

  • Online inhaler videos – every inhaler, spacer and nose spray in easily sharable videos standardised and approved by the UK Inhaler Group.
  • Support and advice for patients through our Helpline and Whatsapp service.
  • Asthma UK’s Facebook and Twitter feeds provide peer support as well as ongoing snippets of self-management support for people with asthma.
  • Our online community connects people, helping them to share their experience with asthma and get advice and support.