Read again: Pioneering sustainable and effective asthma care

A long-term condition like asthma demands vigilant and effective management within the realm of primary care. This article delves into the pivotal role of optimising asthma care practices and discusses how primary care can spearhead a sustainable and patient-centric approach to tackling this chronic respiratory condition.

CREDIT: This is an edited version of an article that originally appeared on GP Online

In the realm of primary care management, practice managers stand at the forefront of ensuring efficient and effective healthcare delivery, making the management of asthma care and inhaler prescription practices a particularly relevant and vital aspect of their roles.

The UK bears the highest rate of asthma in Europe, resulting in a staggering one million asthma attacks necessitating medical attention every year. Hospital admissions associated with asthma have surged by 46% in the past two decades in England and Wales. It’s increasingly apparent that the primary care sector will play a pivotal role in countering these concerning trends.

In this enlightening article, Yang Xu, Director of Medical Affairs for Respiratory & Immunology at AstraZeneca UK, delves into the question of whether the UK relies excessively on SABA inhalers and offers insights into enhancing the landscape of asthma care and treatment.

Are SABA inhalers overprescribed?

Asthma, a well-recognised chronic ailment characterised by airway inflammation and hyper-responsiveness, necessitates appropriate treatment. Inhaled corticosteroids (ICS) are a proven means to manage symptoms and prevent attacks. On the contrary, Short-Acting Beta Agonist (SABA) inhalers, lacking anti-inflammatory properties, have been frequently overused, potentially leading to suboptimal health outcomes.

A large-scale study named SABINA (SABA use IN Asthma), involving 574,913 UK patients, divulged that over a third of them were prescribed three or more SABAs annually, resulting in a notable increase in asthma exacerbations. Additionally, prescribing data suggests that 700,000 people in the UK with asthma solely receive SABA treatment, elevating their risk of attacks, hospitalisations, and even mortality.

Both the Global Initiative for Asthma (GINA) and the UK Primary Care Respiratory Society have cautioned against SABA-only treatment. Unfortunately, the UK holds the highest rate of SABA prescriptions in Europe, potentially contributing to poor asthma outcomes.

Sustainable solutions for asthma care

Patients with uncontrolled asthma leave an ecological footprint three times greater than their controlled asthma counterparts, with SABA inhalers being a significant contributor to that footprint.

Dr Mark Levy, a GP from North West London and the clinical lead for the National Review of Asthma Deaths in 2014, suggests that patients often feel trapped between needing their SABA and wanting to control their asthma. The alternative lies in inhaled corticosteroids (ICS) that address the underlying inflammation and effectively prevent symptoms and attacks.

A decline in asthma reviews

Asthma reviews offer a prime opportunity to engage patients in these crucial conversations. However, the percentage of patients reporting an annual review is at an all-time low, reflecting the pressure on primary care. Nonetheless, it remains essential to optimise treatment and management strategies to decrease the requirement for unplanned asthma care.

Transforming asthma care amidst pressure

SENTINEL, a quality improvement initiative in Hull and East Yorkshire, has provided a successful model to counter overreliance on SABA inhalers. Co-designed with patients and practice staff, SENTINEL supports patients with asthma to transition to alternative care plans, aligning with guidelines and reducing exacerbations. The implementation of SENTINEL within the initial pilot primary care network has proven effective in reducing exacerbations.

Building on the success of the SENTINEL project, SENTINEL PLUS, an expanded quality improvement package, has allowed 300 primary care networks to adopt the programme. The SENTINEL partnership has not only contributed to a reduction in the NHS carbon footprint but has also enhanced asthma care.

The imperative to optimise asthma care and inhaler prescription practices not only aligns with the overall well-being of patients but also contributes to the sustainable and efficient management of healthcare resources. By embracing the insights and strategies outlined in this article, practice managers play an essential role in ensuring that asthma care is not only effective but also environmentally responsible, ultimately enhancing the quality of care they provide to their patients.