Asthma UK Centre for Applied Research

Project: ARRISA-UK

At-Risk Registers Integrated into primary care to Stop Asthma crises in the UK

ARRISA-UK is a randomised controlled trial of GP practice staff training and high risk patient identification and flagging to reduce the occurrence of severe asthma related events.

Preventable hospital admissions

Unfortunately, far too many patients with asthma are admitted to hospital (approximately 72,000) or die (approximately 1150) unnecessarily in the UK every year.

We have excellent drugs available for asthma and clear advice on prescribing them that should allow asthma to be controlled in most patients.

It is known that certain asthma patients are at greater risk of being admitted or dying than others and that targeting intensive support and care to these patients improves their health.

Flagging people at risk – and learning how to help

We have undertaken a study that identified ‘at-risk’ patients within GP practices and used computer-based systems to create pop-up alerts when these patients contact the practice. Practice staff were trained on what to do when they see the alert.

This didn’t reduce the total number of attacks but reduced the hospital admissions as more patients appeared to receive appropriate treatment for their asthma.

Based on these promising findings we wish to undertake a nationwide study to confirm that we can improve the care of these patients without costing the NHS too much or affecting the care of other asthma patients within GP practices.

What are we doing about it?

We will identify patients who are at risk of having severe asthma attacks from GP practices in six regions within the UK, by searching their practice records for factors that predict risk of attacks.

In half of the GP practices, a pop-up alert will appear on the computerised medical notes whenever any of the ‘at-risk’ patients make contact with anyone in the practice. This alert will, for example, remind receptionists to book urgent appointments, GPs and nurses to advise patients to take their medication and follow their written asthma action plans and pharmacists to ensure patients take their medicines.

All practice staff will receive training on how to respond to the alerts, supported by web-based resources and practice study champions, with reminders at 6 weeks and 6 months.

We will use data available routinely from the GP practice and will not need to collect information directly from patients for our study.

After 12 months, we will count how many patients attended Accident and Emergency, had a hospital admission, or died due to asthma in each group.

We will also find out how many people have well controlled asthma, what medications are prescribed for asthma, how often patients attend routine appointments and if they stop smoking.

We will calculate how much this costs and whether it improves (or interferes with) the care of other patients with asthma in the practice.

We will work out which patients gain the most from our study. With their permission, we will arrange focus groups and interview for patients and staff, to discuss their thoughts about the at-risk registers and the training and how it worked in practice. 

Key People

Headshot of Andrew Wilson

Andrew Wilson

Headshot of Gary Barton

Gary Barton

Lead: Preventing asthma attacks Professor of Health Economics
Based at: University of East Anglia Based at: University of East Anglia
Andrew's Profile Gary's Profile
Chris Butler

Christopher Butler

Headshot of Ann Caress

Ann Caress

Co-applicant Co-applicant
Based at: Cardiff University Based at: University of Huddersfield
  Ann's Profile
Allan Clark

Allan Clark

Chris Griffiths

Chris Griffiths

Senior Lecturer in Medical Statistics

Centre Director

Lead: Preventing asthma attacks

Based at: University of East Anglia Based at: Queen Mary University London
Allan's Profile Chris' Profile
Stan Musgrave

Stan Musgrave

Mike Noble

Research Fellow General Practitioner
Based at: University of East Anglia Acle Medical Partnership
Stan's Profile  
Helen Paynter

Helen Painter

headshot of Hilary Pinnock

Hilary Pinnock

Public and Patient Involvement Representative

Lead: Optimising management of asthma attacks,

Lead: Postgraduate Training, Network Coordinator

  Based at: University of Edinburgh
  Hilary's Profile
David Price

David Price

Headshot of Aziz Sheikh

Aziz Sheikh

Professor of Primary Care Respiratory Medicine Centre Director
Based at: University of Aberdeen Based at: University of Edinburgh
David's Profile Aziz's Profile
Headshot of Jane Smith

Jane Smith

Headshot of Ann-Marie Swart

Ann-Marie Swart

Senior Lecturer in Primary Care

Professor of Epidemiology

Director of the Norwich Clinical Trials Unit

Based at: University of Exeter Based at: University of East Anglia
Jane's Profile Ann-Marie's Profile
Professor Mike Thomas

Mike Thomas


Samantha Walker

Professor of Primary Care Research Deputy Chief Executive of Asthma UK
Based at: University of Southampton  
Mike's Profile  


Dec 2014 – October 2021

Contact us

ARRISA-UK study team Clinical Trials Unit Norwich Medical School University Of East Anglia Norwich, NR4 7TJ

01603 593 309

Trial Registration

The ARRISA-UK study is registered with Controlled Clinical Trials: ISRCTN95472706

The ARRISA-UK study is also registered on the UK Clinical Research Network: Study ID=18118.


NHS' National Institute for Health Research's Health Technology Assessment Programme (NIHR HTA)