As a GP, I understand all too well the increasing pressures healthcare professionals face as we head into winter. Cold weather and circulating viruses are common triggers for respiratory symptoms like coughing, wheezing and breathlessness.
This especially affects people with lung conditions whose symptoms often worsen during colder months. Practices across the country will be seeing more people with respiratory conditions, including asthma, who require urgent support.
Last year, new guidelines were introduced by NICE that have the potential to dramatically improve how people with asthma manage their condition. This was years in the making, but Asthma + Lung UK’s latest report shows there are still significant gaps implementing their approach to diagnosing and treating asthma.
Training gap
Its findings highlight a lack of training and funding for primary care professionals to access FeNO and spirometry testing, meaning that many who may have lung conditions can’t access NICE recommended diagnostic tests. The report also found that, too often, people are not being appropriately supported by clinicians when switching over to safer and more effective inhaler regimes.
One of the key changes suggested by the guidance is for people with asthma to adopt AIR and MART inhaler regimes, protecting patients from an over-reliance on SABA inhalers. This switch to using combination inhalers containing inhaled steroids with formoterol, a fast acting LABA, will provide symptom relief equal to SABA.
Combination inhalers provide people with asthma with both immediate symptom relief, as well as treating airway inflammation to support longer term asthma control. When people with asthma are able to manage their condition well, it reduces their need for urgent GP appointments and potential hospital admissions caused by flare ups. It’s a win-win for all.
Next steps
I know that there’s already a lot of pressure on clinicians to stay on top of the latest best practice. But these changes aren’t routine, they fundamentally improve people’s ability to manage their asthma independently and could be lifesaving. The change to single inhaler ICS-formoterol therapy is a dramatic paradigm shift which affects the vast majority people with asthma in the UK, who make up 1 in 11 of our patients.
By replacing SABA-based treatment and addressing the risks of SABA overuse, research shows that severe asthma exacerbations can be reduced by 30-60%. Asthma + Lung UK have accessible online resources to help healthcare professionals get up to speed with the latest guidance.
Many of these changes, such as inhaler switching, must be done collaboratively alongside patients with asthma, to ensure they feel comfortable and understand why they’re making the switch. If people are not involved in changes to their medications, given inadequate advice on what they mean, or not provided with an up-to-date Personalised Asthma Action Plan, it makes it more difficult for them to adopt and stick with their new medication. When people with asthma are given support and guidance to understand and use their new inhaler plans, they’re better able to control of their condition independently and less likely to need additional support.
Consistent advice
What’s also key to cementing the new guidelines is implementing a collaborative surgery-wide approach so that all staff are aware of new best practice. People with asthma should be receiving the same advice and care from all staff at their GP surgery – whether presenting acutely, at a routine review, or when managing patient prescriptions.
Inconsistent advice is not only confusing but undermines clinicians who are adopting new approaches to asthma care. It’s important for surgeries to review and audit practice protocols to ensure they’re upholding NICE’s guidance. Signposting staff to the guidelines and making them aware of just how significant the changes are, helps staff to engage with them and think about how they can implement them in their own roles.
NICE’s asthma guidelines also have a significant impact on the recommendation of FeNO and spirometry testing. These tests are crucial tools in helping diagnose asthma quickly, safely and reliably, especially in children and young people. Research has shown that improved access to FeNO for children and young people with asthma could save the NHS up to £100 million through reduced emergency admissions and more effective treatment.
GP funding
Currently, access to GP funding for these essential tests, machine maintenance and training is a postcode lottery – it’s an injustice to both staff and people with lung conditions. Integrated Care Board’s must step up in making sure GPs have access to funding to roll out these tests. By adopting a common-sense and practical approach to increasing testing accessibility, lung conditions can be more accurately diagnosed and treated before people reach crisis point.
Primary care providers play a leading role in implementing these guidelines, but they cannot act alone. I’ve heard from too many clinicians that community pharmacists and acute care providers have not kept pace with the changes.
Stories of people being solely prescribed SABA inhalers in A&E and urgent care settings show that asthma care is far too disparate. Inappropriate SABA prescribing puts people with asthma at increased risk of experiencing exacerbations of their condition and risks undermining primary care professionals who are already implementing AIR and MART regimes. Correct interventions in emergency settings are incredibly important to preventing people with lung conditions from experiencing further deterioration, re-hospitalisation and even death.
Follow-ups
Up to 82% of people with asthma are not accessing a follow-up review within two days of presenting to emergency care. There’s often a real complacency about the risks associated with exacerbations and poor asthma management. Without appropriate follow-ups after emergency admissions, many people are being set up to fail.
A confusing system means people with asthma may be provided with inconsistent advice that damages their trust and reduces adherence. That’s why it’s vital that everyone’s on the same page. Asthma + Lung UK is here to provide support and reassurance to all those with lung conditions.
These guidelines represented a real turning point for transforming asthma care throughout the country, but we need a united and determined approach to make sure people with asthma receive the support they deserve.
This isn’t the end of the story. Further research on diagnosing, treating and preventing lung conditions is still sorely needed when it remains the UK’s third biggest cause of death.