Asthma: diagnosis, monitoring and chronic asthma management (BTS, NICE, SIGN)

Outcomes

The new BTS, NICE and SIGN guideline, together with the local GIRFT review, provided a catalyst to reconsider and restructure asthma services for children and young people in Brent. This led to an increased focus on asthma and the development of 2 LES schemes, launched in May 2025. The case-finding search has identified 1,877 children in Brent with suspected asthma, and the high-risk asthmatic children search has identified 922 children. Although still in the early stages, within 5 months, 236 children and young people with suspected asthma and 187 children with high-risk asthma have been reviewed. In parallel, the complementary paediatric Core20 health check identified asthma symptoms in 11.2% of Core20 children screened compared with 6.6% in non-Core20 children, and household smoking in 22.6% of Core20 families compared with 11.7% in non-Core20. This provides early evidence of the higher burden of respiratory risk among the most disadvantaged children and supports targeted intervention in line with NICE guidance.

Although the LES reviews are ongoing, initial population health data suggest a 31% average borough-wide reduction in A&E attendances, with a 36% average decrease in the Core20plus5 target population and a 10% reduction in non-elective hospital admissions for asthma in the borough. The BHM team has also been shortlisted for an HSJ award for their work in promoting community asthma management.

Learning

This case study demonstrates that NICE guidelines, while traditionally used for individual patient care, can also be leveraged to reshape services at a place-based level. Critically, this demonstrates how the NICE guidelines are truly adaptable to the unique needs of vulnerable communities when applied appropriately to reduce barriers to care. It also showcases whole-system integration, with coordinated work across primary care, school nursing, community nursing, and community organisations to improve outcomes for children and young people with asthma.