“Improving Asthma Outcomes in the UK – One Year On” APPG Report published

The All-Parliamentary Group for Respiratory Health releases update to 2020 inquiry into asthma outcomes

The All-Party Parliamentary Group for Respiratory Health (APPG) has today released a new report, “Improving Asthma Outcomes in the UK – One Year On”. The paper reviews progress in asthma care since its 2020 inquiry into asthma outcomes, and explores the impact that COVID-19 has had on asthma care in the UK. The report draws heavily on research conducted by Asthma UK Centre for Applied Research and BREATHE Health Data Research Hub for Respiratory Health (BREATHE) experts, including a study into asthma exacerbations as a result of lockdown in England.

In this report, the APPG have raised specific recommendations to help strengthen chronic airways disease management and alleviate the pressure felt by healthcare systems globally. The Centre and BREATHE are delighted to have contributed to this report and the APPG’s recommendations to the Government.

Monica Fletcher, Centre Advocacy Lead was heavily involved in providing evidence from the Centre for both reports. She said:

Delighted to see the APPG Report Improving Asthma Outcomes in the UK - One Year On published today. It builds on the First Report and raises the bar still further with a set of clearly achievable recommendations. These will have a major impact on asthma care if implemented at scale and pace. We need more than just commitment from the clinical community but action from the Department of Health and Social Care, NHS England and Improvement and the new Integrated Care Systems (ICS) to translate these into better outcomes for people with asthma.  Working collectively we can achieve so much more!

The initial APPG inquiry

The 2020 report stated that asthma outcomes in the UK were perceived to lag behind other European countries due to the UK’s fragmented approach to asthma care. On this basis, recommendations for the Government included:

• Improve the accessibility of NHS data through connecting primary, secondary and emergency care networks for a unified approach to asthma care
• Make better use of existing data and technology, for example developing an appropriate clinical code so that data can be better utilised for better outcomes in care and research
• Assess new innovative technologies to help asthma patients attend appointments and self-manage effectively

Updates published in new report

The APPG’s new report gives recommendations based on recently published evidence around asthma during COVID-19 and SABA inhalers and oral corticosteroids, and states the vision for asthma care using a whole systems approach.

Asthma during COVID-19

Respiratory facilities across the world faced intense capacity issues a result of the COVID-19 pandemic. In the UK, asthmatics experienced a 90% drop in face-to-face GP consultations and a 75% fall in specialist referrals. In response to increased demand for respiratory services, NHS England amended sections of the GP Contract to suspend annual reviews and medication reviews for those diagnosed with asthma or COPD.

A study conducted by Asthma UK Centre for Applied Research and BREATHE experts found that primary care admissions for asthma exacerbations in England dropped by a fifth during January-August 2020. Although COVID-related restrictions may account for the fall in the number of asthma attacks reported, many patients were unable or unwilling to seek care during the pandemic.

We found a substantial reduction in asthma attacks after the first UK-wide lockdown in March 2020. At the time, our study was the first national-level investigation that assessed the impact of the COVID-19 pandemic on asthma attacks. Since then, however, several studies have reported similar reductions in other countries. It is now crucial to understand the key factors that are responsible to ensure that lessons can be learnt to help reduce asthma attacks beyond the pandemic.

A 2020 survey conducted by Asthma UK and the British Lung Foundation Partnership found that less than 35% of people with asthma received essential basic care, and nearly half felt that virtual consultations were not an adequate replacement for face-to-face appointments.

While the NHS was quick to implement an innovative virtual consultation system for at-home care during the crisis, in August 2021 over 15% of GPs still recorded less than 20% in-person appointments. In September 2021, NHS England published the “National Bundle of Care for Children and Young People with Asthma”, a whole system approach to asthma treatment, due to be rolled out in 2022. The following month, NHS England published “Our plan for improving access for patients and supporting general practice” and the UK Government announced funding of £250 million to support the plan.

Prescribing alternatives

SABA inhalers and oral corticosteroids (OCS) are linked with adverse side effects if used excessively.

While SABA prescriptions rose by 60% at the start of the pandemic, new studies into Maintenance and Reliever Therapy (MART) have proven it to be an effective alternative. The APPG recommended that:

• the NHS incorporate MART approaches where appropriate
• SABA reduction is incentivised by the NHS
• asthma guidelines include recognition of SABA overuse and suggest alternatives

Biologic therapies are an alternative to OCS for those with severe or difficult-to-control asthma. In 2018, the UK Government announced the ‘voluntary scheme for branded medicines pricing and access’, and in 2021, it was confirmed that biologics for severe asthma would be included in the scheme.

The APPG recommend that the scheme’s implementation, due to end in April 2022 be extended to 2023 to allow more eligible NHS patients to be given rapid access to biologic treatments.

Vision for asthma care

The UK Government’s ‘Life Sciences Vision’, published in July 2021 describes a multidisciplinary exploration of R&D for precision medicines in asthma including diagnostic technology and capacity, however there is a marked absence of a delivery plan or associated resources.

Integrated Care Systems (ICS) are due to become established into UK law in 2022. The APPG recommend that:

• respiratory disease be included as an ICS specification alongside cardiovascular, mental health and cancer outcomes
• respiratory planning and standards are built into the ICS performance framework
• to alleviate capacity pressures on tertiary care, biologics prescribing should be initiated and monitored by secondary care

A whole systems approach

In October 2021, the UK Government committed £5.9 billion to tackle the NHS’s backlog of diagnostic testing. Plans include increasing the number of Community Diagnostic Centres, bed capacity and equipment as well as establishing new surgical hubs. The APPG recommend that respiratory services, including asthma diagnostics are embedded within the new community diagnostic centres, and that there are adequate provisions for onward referral post-diagnosis.

The absence of unified asthma care guidelines for clinicians is a detriment to the level of consistency and efficacy of asthma care. While a draft scope has been developed, severe asthma and the use of biologics were not included. The final iteration is due to be published in 2023, and the APPG recommend that regular updates and opportunities for review are implemented to prevent any further delays.

Read the Report

This report is available from the APPG for Respiratory Health website