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How we can help asthma patients breathe easier – Richard Iles

A consultant in Paediatric Respiratory Medicine looks at the work needed to tackle avoidable asthma deaths and emergencies:

Settling back, with a glass of wine in hand, I have had the opportunity to reflect on the last year of the work of the National Paediatric Asthma Collaborative.

This was formed from the CYP Strategic Clinical Networks across England to progress the improvements set out in the 2014 National Review of Asthma Deaths report.

There is still much to do to reduce the number of avoidable deaths but, just as important, a reduction in the numbers of urgent and emergency attendances that are all too common in this condition.

This is about whole system change, looking across the care pathway, integrated care and improving communication.

It is possible – we only have to look to Finland to see that after a national improvement plan, that re-educated key elements of the workforce. What followed was interesting. Initially there was a rise in asthma diagnosis and cost of treatment, however two to three years later there has been a drastic reduction in the asthma morbidity, the number of asthma admissions and impressively the number of deaths.

Can we reproduce this in the UK? If so, where do we start?

Education – our current practice is highly variable. Please ref to the Atlas of Care and your local CCG data. Outcomes vary from practice to practice, A&E to A&E, ward to ward. Additionally, I think we have all experienced the variability in opinion between clinicians even within units as Asthma action plans are not routinely used or referenced. Consequently we give differing information to our patients, who in turn become confused and despondent and then non-compliant.

The National Paediatric Asthma Collaborative has achieved a number of successes. A number of which have been included in the Healthy London Partnership toolkit.

These include E-learning resource for clinicians, children and their families to support education and training that will improve diagnosis and management particularly in primary, secondary and community care from Health Education England and East of England Strategic Clinical Network.

Special mention needs to go to the innovative work led by Sara Nelson and Donal Markey in the Healthy London Partnership team for the work they undertook with community pharmacies last summer to raise awareness of asthma.  Donal is a London based community pharmacist.

The audit collected very interesting community level data.  It showed of children with asthma in London:

  • 23% live with a person who smokes
  • 64% Didn’t have a flu jab last year
  • 25% Had to make an emergency request for an inhaler in the last 12 months
  • 48% Do have an asthma action plan or wheeze plan

More information can be seen on the My Health London website.

Pharmacists can play a key role in monitoring the use of inhalers in the community with a red flag approach and promoting best practice in inhaler technique. This is a model that could be easily replicated across England.

We have tremendous enthusiasm and commitment across the asthma community including primary and secondary care, to develop a number of useful tools that help commissioners and clinicians understand what good asthma services should look like. These include working documents from a variety of clinical environments.

The toolkit was launched for feedback on 3 May World Asthma day and we will be supporting wider dissemination of this across England.

The improvement landscape has changed somewhat since we began the collaborative, and most of the SCN areas are no longer supporting a children’s programme, but we are confident that this will change in time.

In the meantime, we will look for new delivery partners and in the direction of those who still are involved in this space. The Healthy London Partnership have developed an toolkit for children and young people which aims to support healthcare professionals, schools, parents, carers, children and young people in London in implementing the London asthma standards.

  • On the 5 July the National Paediatric Asthma Collaborative (NPAC) is hosting the National Children and Young People’s Asthma event at the Royal Academy of Engineering in London.

We will be showcasing examples of good practice from across the country aiming to support commissioners and providers to implement improvements across the pathway. The event will:

  • Provide an update on the 2015/16 work of the NPAC and the national context for children’s asthma services.
  • Showcase, the Healthy London Partnership, Children and Young People’s Asthma toolkit to support wider dissemination across England.
  • Learn about new models of care and best practice that can be adopted and spread.
  • Hear about our plans to support ongoing improvement work for this year.

This event will be particularly valuable for those people taking a lead in improving or providing asthma services for children and young people in London. It is aimed at Paediatricians, GP’s, practice nurses, school nurses, ward and community nurses, Clinical Commissioning Group children’s leads, asthma leads, and managers.


Richard IlesDr Richard Iles is a consultant in Paediatric Respiratory Medicine at  the Evelina London Children’s Hospital.

Previously he was a consultant at Addenbrookes’ Hospital in Cambridge.

He held an Honorary Lecturer post in Health Economics at the School of Medicine, Health Policy and Practice, UEA in Norwich from 2004-2010.

In 2013 he became the clinical lead for the high impact change asthma project for the East of England SCN MNCYP and is the clinical lead for National Paediatric Asthma Collaborative, NHS England, and is Clinical Advisor to the Paediatric Asthma Quality Improvement Program for the Health London Partnership.

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