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1. Indicators of Uncontrolled asthma

  • Over previous 12 months (any of):

    • 2 courses OCS for asthma
    • 1 hospital admission/ED attendance for
      asthma
    • 6 SABA prescribed
    • Poor symptom control (as assessed by
      validated questionnaire)
  • On maintenance OCS for asthma
    Indicators of Uncontrolled
    asthma

Support patient understanding of condition and therapy plan using shared decision making resources

Consider use of digital patient information resources and leaflets available here

Home administration of biologic (within 6 months unless clinical contraindications)

2. Primary care

Identification of patients with uncontrolled asthma

Consider proactive identification using search tools e.g. SPECTRA or similar

Diagnostic confirmation

Clinical optimisation

Review and optimise inhaler technique and adherence

Review biomarkers: blood eosinophil count + FeNO

Step up treatment according to national guidelines

Consider other factors that may impact on symptoms including smoking, mental health disease, physical activity and social influences

Start to identify and manage co-morbidities including rhinitis and gastroeosophageal reflux disease

Recommended maximum time for attempting optimisation: 6 months

To refer patients by 6 months (or sooner) if remain uncontrolled

3. Secondary care

Patients to be reviewed and treatment initiated within 18 weeks of referral

Diagnostic confirmation and pheynotyping

Treatment optimisation

Additional investigations as needed

Identification and management of comorbidities

Agreed referral pathway and diagnostics required pre-referral to SAC

3 levels of secondary care services for severe asthma patients based on resource, capability and local agreements:

Tier 1: all patients referred to and managed by SAC

Tier 2: patients referred to SAC; accept patients back after biologic initiation at SAC

Tier 3: local initiation of biologics after approval by SAC MDT

Initiation of biologic in Tier 3 sites

4. Severe asthma centre

Patients to be reviewed within 8 weeks of referral

Diagnostic confirmation and phenotyping

Comorbidity management through MDT input

Additional investigations as needed

Adherence and Treatment optimisation

Severe asthma multi-disciplinary team meeting

Other treatments, research opportunities

Other specialist input: Psychology, Physiotherapy etc.

Initiation of biologic treatment in SAC

Annual MDT
to review ongoing biologic response