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Consensus pathway for managing uncontrolled asthma in adults

The consensus pathway for the management of uncontrolled asthma is now available to view and download. See the full version or the overview

Consensus pathway for management of uncontrolled asthma in adults

Up to 200,000 people in the UK have severe and uncontrolled asthma which has a significant impact on their quality of life.

Many are frequently admitted to hospital as an emergency and run the risk of serious side-effects from extended periods on high dose steroid-based medication. Current service provision is patchy, characterised by lengthy waits and wide variations.

Emerging biologic therapies offer better outcomes for large numbers of these people – but very few are receiving them.

Improving outcomes for patients with respiratory disease is one of the clinical priorities in the NHS Long Term Plan. The NHS Accelerated Access Collaborative (AAC) Rapid Uptake Products (RUP) programme includes improving access to asthma biologics by supporting improvements in pathways and practices to ensure more patients receive timely specialist care.

This programme has produced a consensus pathway which provides a set of standards for the care of adults with uncontrolled and severe asthma based on best practice. It is intended to be a blueprint, guiding clinicians, managers and commissioners on what optimal care should look like across the entire patient journey and leading to real improvements in outcomes.

The consensus pathway was launched at NHS ConfedExpo on 16 June 2022 where Oxford/Wessex Academic Health Science Networks delivered a session at the AHSN Network Innovation Zone on ‘Transforming asthma care through system-wide collaboration and innovation’.

The AAC asthma biologics programme is led by the Oxford AHSN on behalf of the AHSN Network.

Learn more about how the pathway was developed

The consensus pathway for managing uncontrolled asthma in adults

Each part of the pathway diagram above is detailed in the drop down boxes below.

  • Over previous 12 months (any of):
    • 2 courses OCS for asthma
    • 1 hospital admission/ED attendance for asthma
    • 6 SABA prescribed
    • Poor symptom control (as assessed by validated questionnaire)
  • On maintenance OCS for asthma

Support patient understanding of condition and therapy plan using shared decision making resources

Consider use of digital patient information resources and leaflets available here

Home administration of biologic (within 6 months unless clinical contraindications)

Identification of patients with uncontrolled asthma

Consider proactive identification using search tools e.g. SPECTRA or similar

Diagnostic confirmation

Clinical optimisation

Review and optimise inhaler technique and adherence

Review biomarkers: blood eosinophil count + FeNO

Step up treatment according to national guidelines

Consider other factors that may impact on symptoms including smoking, mental health disease, physical activity and social influences

Start to identify and manage co-morbidities including rhinitis and gastroeosophageal reflux disease

Recommended maximum time for attempting optimisation: 6 months

To refer patients by 6 months (or sooner) if remain uncontrolled

Patients to be reviewed and treatment initiated within 18 weeks of referral

Diagnostic confirmation and pheynotyping

Treatment optimisation

Additional investigations as needed

Identification and management of comorbidities

Agreed referral pathway and diagnostics required pre-referral to SAC

3 levels of secondary care services for severe asthma patients based on resource, capability and local agreements:

Tier 1: all patients referred to and managed by SAC

Tier 2: patients referred to SAC; accept patients back after biologic initiation at SAC

Tier 3: local initiation of biologics after approval by SAC MDT

Initiation of biologic in Tier 3 sites at 4 weeks

Patients to be reviewed within 8 weeks of referral

Diagnostic confirmation and phenotyping

Comorbidity management through MDT input

Additional investigations as needed

Adherence and Treatment optimisation

Severe asthma multi-disciplinary team meeting

Other treatments, research opportunities

Other specialist input: Psychology, Physiotherapy etc.

Initiation of biologic treatment in SAC at 4 weeks

Annual MDT
to review ongoing biologic response


Implementation resources

Understanding Opportunities for Improvements

Implementation Tools and Resources

Asthma Biologic Pathway Transformation Fund Projects

The Pathway Transformation Fund (PTF) has been made available to NHS providers to deploy innovative ideas to overcome barriers to the adoption of Asthma Biologics within their locality. A list of the PTF project sites is available here.