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)
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