New focus on asthma – Bev’s blog
New focus on asthma – Bev’s blog
We have all had something of a torrid time with the pandemic, caring for people with COVID and supporting each other through challenging times, and our roles and experiences have changed, sometimes quite dramatically. Interestingly, however, several speakers at the winter BTS meeting reported a significant reduction in asthma attacks during the pandemic and it was postulated that improved hygiene practices along with self-isolation and lockdown had reduced exposure to triggers for asthma exacerbations. Someone suggested that an annual lockdown in winter would be good for people living with asthma and good for NHS especially with regard to winter pressures! However, we all recognise that the holistic care of people with asthma is a bit more complex than that 😊
While all of this has been going on, some of the ARNS team have been involved in some really exciting projects looking at how we improve asthma management in primary, secondary and tertiary care moving forward. Firstly, the Accelerated Access Collaborative has been looking at how to improve the identification of people who potentially have severe asthma and ensure they are appropriately referred to enable identification of those who might benefit from a biologic therapy. It is recognised that the number of people who fit these categories is far higher than the number actually being identified and referred. The severe asthma AAC has several arms and I am heading up the group which is responsible for supporting the education of primary care clinicians in these aspects. I’m working with a multi-disciplinary team – GP, chest consultant, pharmacist, Academic Health Science Network – a merry bunch indeed! Having ascertained what’s needed in said education programme we have now submitted a bid for funds to develop and deliver two modules, three webinars with live Q&A sessions, podcasts, posters and a simplified referral form for primary care to ensure better (in very sense) referrals. Watch this space!
Aligned with this topic, ARNS has also been represented on the FeNO working groups taking place and which are focused on improving access to FeNO, including offering funding for more FeNO testing. Of course, it’s not just about the equipment, though. We need clinicians to understand where FeNO fits into the broader process of diagnosis, what it is and what it isn’t and importantly, how to carry out and interpret the test. The FeNO group has included patient representatives whose lives were transformed by FeNO testing and it’s been very moving hearing their stories. I know that in previous ARNS conferences, the patient perspective has always delivered a powerful message. Locally, I organised some (free) FeNO training via one of the companies and the local respiratory technicians have now commissioned it for their team. The working group is still in progress and bids for FeNO funding via the Transformation Pathways have gone in so hopefully we will soon see this test available in practices and (maybe) Primary Care Diagnostic Hubs.
Speaking of which…spirometry! So those working in secondary care probably wonder what all the fuss is about with ‘restarting’ spirometry in primary care. NHSEI has drafted guidance on the topic and the (draft) message is, in essence, for primary care to crack on. ARNS has been involved in commenting on draft guidance on this and at the time of writing, it has still not been published. The statement that spirometry is not aerosol generating but coughing during spirometry is, caused us to pause for thought, as did the recommendation to have a fan in the window, with some of us thinking extractor fan (needs professionally fitting) and others wondering about electric fans balanced precariously on window ledges/sills, suggesting that the guidance needs clarification! In the meantime, many primary care colleagues, especially those working in older practices, wonder how on earth the necessary infection control interventions can be put in place in time (or ever) to allow spirometry to restart. That’s what makes the concept of diagnostic hubs so seductive, I reckon.
Anyway, that’s a quick insight into some of what I’ve been up to in my ARNS role. I haven’t even mentioned the ground-breaking ERS nurse education groups that has been set up with ARNS representation – initially this was without the support of the wider ERS organisation, but then, when we decided to go ahead without them, they suddenly realised we were going to be a force to be reckoned with and jumped back in! Maybe that’s one for another blog.
If you’d like to catch up on any of these points, drop me a line: Beverley.bostock@nhs.net.