31 Jan 2023
Binita Kane: Improving asthma care in Greater Manchester
Asthma currently affects more than 5.4 million people across the United Kingdom, with 200,000 people across Greater Manchester living with this condition.
There is no cure for asthma, but with treatments available, patients can keep their symptoms under control and provide temporary relief with the use of inhalers.
After assessing the patient pathway, Health Innovation Manchester is now collaborating with global pharma company, AstraZeneca, and software company LungHealth on a project to transform the diagnosis and management of asthma patients across the region.
The Standardised Asthma Reviews and Reduction in SABA model in Greater Manchester (STARRS-GM) project, aims to improve the outcomes for people living with asthma in the region through proactive identification and reviews with high-risk patients to optimise their asthma management.
In this blog, Dr Binita Kane, Respiratory Lead at Health Innovation Manchester, analyses the asthma pathway, and provides insight on the STARRS-GM work currently being delivered across Greater Manchester’s health and social care system.
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). The project aims to improve the outcomes for adults living with asthma in the region, through proactive identification and reviews with high-risk patients to help optimise their asthma management.
According to Asthma & Lung UK, every three seconds in the UK someone is having a potentially life-threatening asthma attack. Every day, the lives of three families are devastated by losing a loved one to an asthma attack, the very sad part is that two thirds of these are preventable. 1.
Over the last two decades, there has been progress in asthma care, but when compared to other areas such as reducing deaths from car accidents or from epilepsy, asthma is seriously lagging-behind. 2.
Every report into asthma deaths between 1963 and 2014 has had similar findings, citing that; inadequate assessment, underuse of ‘preventer’ steroid inhalers, excessive use of ‘reliever’ inhalers (indicating poor asthma control), failure to follow established guidelines and lack of specialist input contributed to asthma deaths.22.214.171.124.7.8.9.
Asthma impacts the lives of millions across the UK. Poor control can lead to daily symptoms of cough, chest tightness and wheeze. The cost to the UK economy is thought to be around £4 billion per year in days lost through work, hospitalisations, and the cost of medication. 10.
I spent many years working in the severe asthma service at Wythenshawe Hospital. The service would see people from all over the North-West, a large multi-disciplinary team carrying out detailed assessments and providing potentially life-changing biologic drugs. However, I became increasingly frustrated seeing the ‘missed opportunities’ in the years leading up to referral.
By the time we were seeing patients, they often had terrible side effects from multiple courses of oral steroid tablets, their inflamed airways had become stiff and narrow through years of undertreatment, many had the wrong diagnosis or other factors causing their symptoms. Many had left their careers and were struggling to look after their children.
Sometimes a very simple intervention like changing their inhaler or correcting how they were taking made a big difference. In others, they required much more intensive therapy, but the inequalities in access to care and treatment and variation in standards of care were plain to see.
Asthma care has evolved greatly over the last 20 years, there has been an explosion in the science and number of therapies available. It’s difficult enough for us specialists to keep up. Primary Care clinicians can’t be expected to be abreast of all the latest developments, they have every other condition to look after too. Access to specialists remains difficult and inequitable, with long waits for specialist services. So, we need to do something differently.
When the opportunity to work with Health Innovation Manchester came along, I jumped at it with open arms. Fast forward 5 years, an ambitious project to improve the lives of asthmatics across Greater Manchester is underway.
The STARRS-GM programme is evaluating the impact of introducing artificial intelligence-guided software into GP practices that supports and enables clinicians to ensure the latest asthma guidelines are being followed. Practices are supported with an education package and have access to an online meeting with an asthma consultant and specialist senior asthma pharmacist.
We have also introduced exhaled nitric oxide testing, a bedside tool that allows measurement of inflammation in the lungs that can help guide treatment and explore different models of working. A particularly exciting development has been a community pharmacist taking the lead role in one area. This has allowed asthma reviews to take place outside of the GP surgery, whilst having access to the same quality review using the software. Patients have been dispensed medication and taught how to use it then and there, including inhalers and treatments for smoking cessation.
2. Blakey J et al ‘Assessing the risk of attack in the management of asthma: a review and proposal for revision of the current control-centred paradigm’, Primary Care Resp Journal 2013
3. ‘Asthma deaths in Cardiff 1963-1974: 90 deaths outside hospital’ BMJ July 1976
4. British Thoracic Association. Death from asthma in two regions of England. BMJ 285:1251–1255
5. British Thoracic Society, Research Unit of the Royal College of Physicians of London, King’s Fund Centre, National Asthma Campaign. Guidelines for management of asthma in adults: I—chronic persistent asthma. BMJ 1990; 301: 651–653
6. National audit of acute severe asthma in adults admitted to hospital. Standards of Care Committee, British Thoracic Society, Qual Health Care. 1995 Mar; 4(1): 24–30
7. ‘Scottish Confidential Inquiry into Asthma Deaths (SCIAD) 1994-6’ Thorax 1999, 54 (11):978– 84
8. An ongoing Confidential Enquiry into asthma deaths in the Eastern Region of the UK, 2001–2003. Prim Care Respir J 2005;14(6):303–13
9. National Review of Asthma Deaths, Royal College of Physicians 2014 https://www.rcplondon.ac.uk/projects/national-review-asthma-deaths
10. Nunes C, Pereira AM, Morais-Almeida M. Asthma costs and social impact. Asthma Res Pract. 2017 Jan 6; 3:1
GB 40972 Date of preparation January 2023