Introduction & module overview

Lung conditions kill more people in the UK than anywhere else in Western Europe. More than 12,700 people have died from asthma in England and Wales in the past decade with deaths increasing by 33 per cent between 2008-18. Tragically, more than three-quarters of these deaths were preventable.

Asthma has a greater prevalence in more deprived communities. Those living in the most deprived areas in England are more likely to go to hospital for their asthma. Those from disadvantaged socio-economic groups are more likely to be exposed to the causes and triggers of asthma, such as smoking and air pollution.

Patients living with asthma can lead normal productive lives but, in many instances, if their asthma is not well managed, it can lead to day and night-time symptoms, interference with school or work activities, and an increased reliance on short-acting beta-2 agonist (SABA) medication (still often referred to as the ‘blue’, ‘reliever’, ‘rescue’ or ‘emergency’ treatment).

Basic care

Basic asthma care includes an inhaler technique check/coaching, an up-to-date personal asthma action plan (PAAP), an annual asthma review and a discussion around environmental factors (e.g. second-hand smoke, air pollution, cold or poor quality housing) that can adversely affect the condition. With a stretched NHS workforce, this may not be happening routinely with opportunities missed to spot worsening asthma.

Respiratory care is a key priority in the NHS Long Term Plan and the 2024 Darzi Report says preventative care is important in reducing mortality and time spent in ill health. The 2024/2025 NHS England medicines optimisation guidance prioritises several respiratory areas including reducing the carbon footprint around inhaled treatments.

There is also good data available to highlight local Index of Multiple Deprivation (IMD) pollution data, enabling pharmacy teams to signpost to services and utilise social prescribers where possible.

The new NICE/BTS/SIGN guidance on the diagnosis, monitoring and management of chronic asthma recommends greater use of blood tests and FeNO monitoring, which measures fractional exhaled nitric oxide. Both measure inflammatory markers to help with supporting asthma diagnosis.