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

Implementation

We used NICE guidance to identify useful tools and medications which would allow us to achieve our objective of improving asthma management.

Linking together paediatric asthma and a household approach to smoking cessation allowed us to work with many partners, including the NHS GM Treating Tobacco Dependency Team, the Strategic Clinical Network children and young people team, The Royal Oldham Hospital (ROH), the local stop-smoking service Your Health Oldham, and the Smoke Free app. Harnessing expertise from all these partners was invaluable in developing a joined-up pathway for paediatric asthma management.

The work took place at ROH, offering patients fractional exhaled nitric oxide (FeNO) testing (see the NHS webpage on FeNO) on the ward to monitor inflammation of the lungs, and offer advice and nicotine replacement therapy with support to be smoke-free and ultimately become healthier as a result.

Continued support has also been provided for patients, with a repeat test offered in a community-based setting as part of a follow-up asthma consultation. If the child or young person's asthma is determined to be uncontrolled despite optimising treatment and addressing triggers, they will be referred onto the asthma biologics pathway to assess whether they are eligible for biologic therapy medication – these are specialist treatments using antibodies produced from cells in a laboratory, which can target specific cells in the body.

This 6-month pilot launched in February 2023. This took a whole-household approach to asthma intervention, working with ROH Children's and Paediatric Observation and Assessment Unit to help identify children and young people admitted to hospital with asthma or respiratory illnesses, who smoke or live in a household that smokes. Young people identified as smokers would be referred to the local stop-smoking service, while adult household members identified as smokers were offered the Smoke Free app, which entitled them to 6 months' free access to all premium features as well as up to 12 weeks' free nicotine replacement therapy and/or refillable vaping kit. Those that were unable to use an app were referred to the local stop-smoking service, Your Health Oldham.

In addition, we identified the need for educational resources to aid asthma management. This stemmed from anecdotal evidence that highlighted a lack of understanding about the impact of parental smoking on their child's asthma. After a workshop with key project partners, we also identified a gap in educational resources that provided guidance to help young people self-manage their asthma.

We then engaged with the community to gain insights into their understanding of asthma triggers and management for children and young people, and confirm their want and need for education outside of the healthcare setting. We held 8 focus groups in Oldham, engaging with 90 adults and young people within the target demographic to understand:

We also took onboard their suggestions for what messages and resources would influence them to manage their asthma or their child's asthma better. This led to the co-production and co-design of a suite of resources, including leaflets, animations and social media posts.

The national programme funded procurement of FeNO devices and consumables, Smoke Free app licences, training and the community engagement and development of educational resources.