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BLOG SERIES: Is the UK still struggling to significantly improve asthma outcomes? Reflections on the COVID-19 era

Monica Fletcher OBE, Advocacy Lead at the Asthma UK Centre for Applied Research reflects on the year since our webinar in association with the Primary Care Respiratory Society

Back in May 2020 - in the midst of the first COVID-19 lockdown - The Asthma UK Centre for Applied Research co-hosted a webinar in association with the Primary Care Respiratory Society called ‘Why is the UK still struggling to significantly improve asthma outcomes?’ Speakers from a wide range of backgrounds offered their personal reflections on the current state of asthma care in the UK. We also heard their thoughts on how improvements could be made.

Graphics to explain the presentations at asthma outcomes webinar
Illustrations from asthma outcomes webinar, May 2020

Now 12 months on, we are reflecting on what has happened to those hopes and aspirations and how the COVID pandemic may have impacted both negatively, but also positively by creating a catalyst for change, such as online consultations for asthma reviews.

Fortunately the risk of severe COVID-19 in people with asthma turned out to be relatively small[1], but this certainly was not known in the early months of the pandemic.

There has been evidence to show that the numbers of asthma exacerbations seen in GP practices dropped by 20% in England during the first lockdown[2]. Similarly, emergency departments in Scotland and Wales saw 36% fewer people with asthma[3]. It is interesting to postulate why.

It is possibly due to improvements in air quality or less exposure to asthma triggers including the usual common respiratory tract infections. At the start of the first lockdown there also appeared to be an increase in people requesting prescriptions for their asthma medications – indeed for some meds there were short term shortages - maybe reflecting an increase in adherence. It could also be that people just dealt with their asthma exacerbations at home because they were reluctant to visit their GP or hospital out of fear of catching COVID-19.

Asthma outcomes

An international panel of respiratory experts published a paper in 2020[4] on improving asthma outcomes in primary care which concluded that a holistic approach to asthma management gave greater benefit than individual interventions.

The All-Party Parliamentary Group on Respiratory Health concur that a range of interventions are required to improve asthma. Their inquiry into asthma outcomes in the UK questioned why asthma outcomes aren’t improving in the UK, comparing the figures here with several European countries. In their report[5] published in 2020, they identified the fragmented approach to asthma as a key issue contributing to the UK being perceived as lagging behind other countries.

Their recommendations included:

  • rolling out diagnostic hubs for respiratory illness, including asthma across primary care
  • the creation of an appropriate clinical code for severe asthma
  • A merger of the NICE and BTS/SIGN guidelines and a 12-monthly review process

It’s hoped that these recommendations, if acted upon, will be the beginnings of a joined-up, multidisciplinary approach to the way asthma is diagnosed, treated and managed in the UK.

Updated viewpoints of asthma care in the UK

For World Asthma Day 2021, we invited some of the speakers we had in last year’s webinar to create a blog series to reflect on the changes brought about by the global pandemic (if any) and how they have affected asthma care in the UK. Over the next few weeks we’ll share how their professional and personal views have changed since the beginning of lockdown. You can look forward to a wide range of perspectives, including:

  • Third sector perspective
  • National policy perspective
  • Primary care perspective
  • Community pharmacy perspective

Once we’ve had the individual viewpoints, we’ll set out the future of asthma care in the UK in the post COVID-era with a blog from Dr Katherine Hickman, GP, Vice-Chair of the Primary Care Respiratory Society.

Are we on the right steps to improving asthma outcomes in the UK? We’re looking forward to hearing your views and opinions. Join the discussion and debate on Twitter and LinkedIn in the coming weeks!

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Watch the webinar again

Watch our webinar ‘Why is the UK still struggling to significantly improve asthma outcomes?’ hosted in association with the Primary Care Respiratory Society.

Watch again on YouTube  

References

[1] Aveyard, P., Gao, M., Lindson, Nicola, Hartmann-Boyce, J., Watkinson, P., . . . Hippisley-Cox, J. (2021, April 01). Association between pre-existing respiratory disease and its treatment, and severe COVID-19: a population cohort study. The Lancet Respiratory Medicine. doi:10.1016/S2213-2600(21)00095-3

[2] Shah, S. A., Quint, J. K., Bright, N. I., & Sheikh, A. (2021, March 29). Impact of COVID-19 national lockdown on asthma exacerbations: interrupted time-series analysis of English primary care data. BMJ Thorax. doi:10.1136/thoraxjnl-2020-216512

[3] Davies, G. A., Alsallakh, M. A., Sivakumaran, S., Vasileiou, E., Lyons, R. A., Robertson, C., & Sheikh, A. (2021, March 29). Impact of COVID-19 lockdown on emergency asthma admissions and deaths: national interrupted time series analyses for Scotland and Wales. BMJ Thorax.

[4] Fletcher, M.J., Tsiligianni, I., Kocks, J.W.H. et al. Improving primary care management of asthma: do we know what really works?. npj Prim. Care Respir. Med. 30, 29 (2020). https://doi.org/10.1038/s41533-020-0184-0

[5] All-Party Parliamentary Group for Respiratory Health. (2020). APPG Report: Improving Asthma Outcomes In The UK

 

Image credit: www.listenthinkdraw.co.uk