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Research project

DEFINE: Development and evaluation of a FeNO-guided asthma management intervention in primary care

Project overview

According to Asthma UK, around 5.4 million people in the UK receive treatment for asthma. Asthma costs the NHS at least £1.1 billion each year, and on average almost 300 people each day are admitted to hospital with an asthma attack. There is no cure for asthma, and long-term treatment is needed to control symptoms and stop asthma attacks, which can be life threatening. The UK has one of the highest asthma death rates in the world, with on average over 3 people dying from asthma each day. Most asthma deaths and many asthma attacks could be prevented by better treatment. Treatments include ‘reliever’ inhalers to open up the airways and ‘preventer’ inhalers, which contain steroids to reduce swelling (inflammation) in the airways. People can mostly control their asthma by taking preventer inhalers every day to reduce inflammation and reliever inhalers if they feel wheezy or breathless. However, for more serious flare-ups (exacerbations), people may need steroid tablets, or even admission to hospital.

Monitoring inflammation in asthma: using FeNO in general practice
Asthma is a difficult condition to treat because how people feel does not always match how much inflammation is in their airways. Doctors and nurses in hospital clinics therefore sometimes use a simple breath test called fractional exhaled nitric oxide (FeNO) to measure inflammation in the airways. This helps them make sure that patients are taking their inhalers properly and are on the right dose of treatment to control inflammation in their airways and prevent serious flare-ups Measuring FeNO can also help doctors and nurses reduce treatment safely in patients who are not benefitting from it. This could potentially lessen side-effects from medicines, improve quality of life, and save costs.

Asthma UK says that around 75% of asthma patients had a check-up in their GP surgery in 2017. However, it is not clear from previous research whether FeNO should also be measured during these check-ups. At the moment, FeNO tests are generally only offered to people with severe asthma who attend a hospital ‘difficult asthma’ clinic. However, it may be that using these tests more widely in general practice would help cut asthma attacks and help decide when the inhaler doses can be cut back or need to be increased. The National Institute for Health and Care Excellence has asked for further research on this question.

Research plan

Our research will:
Produce an online training and support package for doctors and nurses in GP surgeries to help them use FeNO to target and adjust asthma treatments more effectively.
See how much our online package reduces serious flare-ups and improves quality of life.
Produce evidence to help policymakers make asthma services more efficient and cost-effective.

Who will be involved?
We will work with asthma experts, GPs, nurses and patients to develop our online training and support package. We will also ask health care professionals and patients at GP surgeries to try out our package and suggest improvements. To find out how well the package works, we will do a research study involving over 2500 asthma patients from around 130 GP surgeries.

Patient representatives will be involved at all stages of the research, including helping to design study materials and information leaflets and making sure that the way we run our study is acceptable to patients.

This project is being conducted by the Primary Care Research Centre.


Other researchers

Professor Paul Little

Professor in Primary Care Research

Collaborating research institutes, centres and groups

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