29 December 2021

Blog by Dr Julia Reynolds, Associate Director of Transformation

Dr Julia Reynolds

Associate Director of Transformation

For more information and support from the AHSN, please contact

In the north west coast, there are a large number of people who experience respiratory problems and we have some of the highest asthma prevalence in the country. Our industrial legacy, ongoing environmental factors and lifestyle, contribute to these health challenges. We always have challenges to address and our NHS community have highlighted that respiratory problems are a major challenge. The Innovation Agency can support amplifying and accelerating improvements to improve the lives of many of our residents.

Although many people who have asthma or breathing problems are well managed on an inhaler, there are some who are not, and the threat of an asthma attack or disruption to breathing can have a very profound effect on people’s lives and well-being.

We know that COVID has made the ongoing management of asthma very challenging, with many asthma patients, not receiving regular follow-ups and support with inhaler techniques and checks on well-being that they might usually have face-to-face. During this period prescribing teams were mindful that inhalers needed to be given to patients to help protect them, but often face-to-face appointments were not possible. We also need to be mindful of the green agenda and the prescription of multiple inhalers might benefit from being reduced in many cases.

There is a large unmet need in our area. The North West has 16% of asthma patients who have been prescribed two of more courses of steroids in a year, which is a sign of uncontrolled asthma and the second highest numbers in England. There are also potentially 8% of patients on asthma registers, who may have severe asthma, but have not been diagnosed or referred to specialist services. This issue is of pressing importance to our community and our patients. By supporting our teams with new tools, new ways of working and highlighting innovation, we can help support improved access to treatment and the latest medication.

Academic Health Science Networks are supporting initiatives in our region and have supportive tools to help clinicians, with diagnosis using FeNO and to identify those with potentially severe asthma more easily. We are proud of our teams who have risen to local challenges to improve services for respiratory patients, despite the challenges in the system.

Clinical colleagues have helped develop:

  1. Tools to support finding patients who are undiagnosed with asthma

  2. Tool to support patients with potentially severe asthma

  3. Access to a toolkit to support clinical staff manage asthma patients – focussed on FeNO

  4. Training for using FeNO machines to aid diagnosis 

  5. Asthma toolkit for supporting pathway change, with lots of useful information from across the country

  6. Risk stratifying for asthma and online support tools – the UCLP framework for Proactive Care@home

The toolkits are regularly updated with new and useful information.

A number of GPs and respiratory nurses and other professionals, in Knowsley, Central Lancashire and Liverpool have used these tools and have incorporated FeNO into their everyday diagnostic toolkits and feedback has been very positive from staff and patients.

Over the next two years, we hope that every practice will have access to FeNO testing and strong knowledge and skills to help improve the asthma pathway and improve quality of life in being well managed and receiving the best care.

I am personally very proud to be working with such innovative and forward-thinking colleagues who are committed to continual improvement and go above and beyond in improving the lives of their patients.

For more information and support from the AHSN, please contact

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