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

Overview

The Living Well Partnership primary care network (PCN) in Southampton, Hampshire, is one of the largest PCNs in the region, with over 46,000 registered patients and more than 3,500 asthma patients (adults and children). The PCN employs 3 respiratory nurse specialists (RNS), who lead a dedicated respiratory diagnostics hub.

In December 2021, the respiratory lead, supported by GP partners, nurse services lead, and a GP with a special interest (GPSI), developed a new respiratory pathway to improve early and accurate diagnosis of chronic lung disease and enhance patient outcomes. Initially, suspected asthma patients were managed with a GP face-to-face review, investigations (such as chest X-ray and full blood count), and referral to the RNS team for diagnostics. At that stage, patients were commenced on a short-acting beta agonist (SABA) with a spacer.

Following updates to the Wessex Asthma Guidelines in 2023, which incorporated maintenance and reliever therapy (MART) and anti-inflammatory reliever (AIR) approaches based on Global Initiative for Asthma (GINA) recommendations, the pathway was revised. Suspected adult asthma patients were now started on an inhaled corticosteroid (ICS)-formoterol combination inhaler licensed for PRN use, rather than SABA. This ensured patients received anti-inflammatory treatment from the very start of their diagnostic journey.

In late 2025, the pathway was updated again to extend this approach to children aged 12 years and above. This change further reduces the risk of SABA overuse and aligns with BTS, NICE and SIGN Asthma guidelines, which recognises the challenges of asthma diagnosis and the importance of strong history-taking, symptom review, and objective testing (fractional exhaled nitric oxide [FeNO], spirometry with reversibility, peak flow diaries).