Patients living with asthma in Greater Manchester have seen the diagnosis and management of their condition improve through the use of Fractional Exhaled Nitric Oxide (FeNO) testing model, which measures the level of nitric oxide in their breath and helps to differentiate their type of asthma.

As part of this care, patients who have been involved with the Standardised Asthma Review and Reduction in Short-Acting Beta Agonist (SABA) model in Greater Manchester (STARRS-GM) project have had their asthma evaluated through structured asthma reviews.

These reviews particularly focused on tackling uncontrolled asthma by identifying patients who have an over-reliance on blue reliever (SABA) inhalers, a sign that asthma may not be well-controlled, increasing the risk of an asthma attack.

Health Innovation Manchester has a joint working agreement with AstraZeneca and is working through the Standardised Asthma Review and Reduction in SABA model in Greater Manchester (STARRS-GM) using LungHealth software, via National Services for Health Improvement (NSHI).

Health Innovation Manchester together with AHSNs across the country, has worked in collaboration with NHS England, The AHSN Network and the Accelerated Access Collaborative (AAC) to implement the FeNO testing model across primary care and community pharmacy.

For patients presenting with asthma symptoms, over 1,600 appointments were attended and over 1,400 patients were reviewed through the STARRS-GM pathway, helping to improve an understanding of their condition.

These reviews helped to confirm that patients are receiving the correct treatment and saw a reduction in the number of SABA inhalers used as well as helping to improve their asthma control, with over 300 patients assessed for inhaler technique.

Piloting this test in a community pharmacy setting has increased access for patients, with 48 face-to-face community pharmacy appointments attended to date. This has the potential to reduce the pressure on already over-stretched services in primary care.

Dr Binita Kane, Respiratory Lead at Health Innovation Manchester, said: “FeNO provides a numerical value which can indicate how much inflammation there is in the lungs, the root cause of asthma. For a patient, seeing that the levels are high helps to foster an understanding of why their asthma is out of control and cement the importance of taking preventer inhalers. We know that from the National Review of Asthma deaths published in 2014, underuse of preventers was a big contributory factor. We have demonstrated with this pilot that the FeNO test can be used in a Community Pharmacy setting to understand why someone’s asthma is poorly controlled and personalise their treatment accordingly. We ensured that our Community Pharmacist had access to expert support from a Respiratory Physician whenever needed. This is ground-breaking as it can take the onus of asthma reviews away from overstretched doctors and nurses in Primary Care.”

Andy Sumpter, Head of Population Health at AstraZeneca, said: “FeNO testing along with a focus on reducing the over-reliance to SABA inhalers in uncontrolled Asthma patients is an important step in improving Asthma care for patients in Greater Manchester. SABA inhalers do not treat the underlying inflammation caused by asthma, and SABA over-reliance is associated with an increased risk of asthma exacerbations and premature death. In addition, it also has a significant negative impact on the environment, so it is wonderful to see the positive impact seen through the STARRS-GM project for patients living with asthma in Greater Manchester.”

Sunil Thacker, Director at Thacker’s Pharmacy in Wythenshawe, said: “FeNO has been invaluable for me with my asthma reviews. Patients understand the importance of the steroid inhaler with education around the FeNO result and seeing a drop in value for the follow up, instils confidence with both the patient and the healthcare professional in understanding the appropriateness of the steroid inhaler strength being used. Long term if we could continue to use FeNO for the relevant asthma patients, a quick consultation and FeNO reading whilst picking up their asthma medication would reiterate how the patient’s asthma control is. I can see this model working elsewhere as long as the health care professional is upskilled to confidently provide information about the result.”

Cath Barrow, Senior Programme Development Lead at Health Innovation Manchester, said: “When the opportunity arose to utilise FeNO testing in a different setting, we jumped at it. We had an enthusiastic community pharmacist with support from our secondary care clinical lead and a Primary Care Network (PCN) Lead who bought in to giving this model a go. With some short-term investment, we were able to test whether a model for FeNO testing in community pharmacy could work. This was a leap of faith that has resulted in a model that benefits patients who might not ordinarily be able to access their GP, but could access their community pharmacy for an asthma review including FeNO testing and upskilled a community pharmacist who now has the confidence to treat asthma patient.”

GB 44429 Date of Preparation September 2023