There are several groups of medication and treatments used in the management of asthma.

• Short acting bronchodilators
• Long-acting bronchodilators
• Inhaled corticosteroids
• Anti leukotrienes
• Theophylline’s
• Antimuscarinics
• Oral steroids
• Anti IgE treatment
• Biological treatment

• Allergen avoidance
• Weight reduction
• Smoking cessation – avoid passive or active exposure to smoking
• Breathing therapies help to reduce symptoms. ​ Common breathing techniques for asthma include the Buteyko method and the Papworth method.
• Immunisations

The Nebuliser Service is run by appointments only.

PLEASE DO NOT WALK INTO THE DEPARTMENT WITHOUT AN APPOINTMENT AS YOU MAY NOT BE SEEN DURING BUSY PERIODS.

The Nebuliser Service is part of the Respiratory Physiology Department, at Royal Stoke and Lung Function Department, at County Hospital.

We provide a number of services:

• Yearly loan nebulisers - a nebuliser is loaned to you for 12 months. This is the main service we provide.

• Provision of consumables lasting for 12 months to use with the nebuliser loaned to you.

• Limited Holiday loan nebulisers on request - smaller portable nebulisers that can be used for holidays. Please ring us to arrange collection.

Please do not hesitate to ring us if you have

any questions about the service we provide.

YEARLY SERVICE APPOINTMENT

You will be sent a letter in 12 months time providing an appointment for you to bring the nebuliser back to us for its annual service. Providing your machine is still in service date, you will be given the same machine back following checks, along with all consumables, when you attend this appointment.

The service appointment does not take very long and you do not have to attend the

appointment yourself—a relative or friend can return and collect the nebulisers on your behalf.

Please ring if you cannot attend your appointment or wish to re-arrange it.

Asthma reviews
It is an important aspect of asthma management to attend an annual asthma review at the GP surgery.  It will help you to make sure you're on the right asthma plan.  Everyone with asthma should have an asthma review at least once per year – those with severe asthma should have one more often.  You should go, even if you feel well – it is your chance to make sure your asthma stays well managed so that you can get on with doing the things you enjoy. 

To complete an Asthma Control Test questionnaire click on the link- Asthma control test

Medication
The best way to stay on top of your asthma is to remember to take your prescribed medication as directed by your GP/Practice nurse or Asthma team. If you develop any side effects from the medication, please make an appointment at your GP surgery for a review.  It is crucial to continue to take your preventer medication every day to control your asthma.  If you need to use your reliever medication three times per week or more on a regular basis, you should seek a medical review.  If you have severe asthma and your reliever medication does not relieve your symptoms for four hours, you should seek an immediate medical review.

To obtain information about prescription costs and/or purchase a prepayment certificate (it could save you money!) visit the NHS Choices​ website.

Personal Asthma Action Plan (PAAP)
You should have a written plan of action, including peak flow readings, so you will know what to do if your asthma gets worse, or if it gets better.  Your personalised plan can be completed by your GP, practice nurse or hospital asthma team.  Try and remember to take your management plan to all of your asthma appointments so that it can be reviewed or updated as necessary.

Click to download – Peak flow diary https://shop.asthmaandlung.org.uk/products/peak-flow-diary

Click to watch – How to use a peak flow metre

https://www.youtube.com/watch?v=UQa74XtQXf8&t=3s

Doing this helps to see if your peak flow changes over time. It can help you understand when your symptoms are getting worse and what could be triggering them.

Monitoring peak flow could cut your risk of an asthma attack. It can tell you if your medication is working or if you need to change the amount you’re taking

Checking your peak flow at home is most useful if you’re recovering from an asthma attack, or your treatment plan has changed.

To keep a record of how well you've been and show this to your GP or asthma nurse at your annual review or in preparation for upcoming asthma appointments at the Hospital.

Act quickly if your peak flow tells you, it's an asthma emergency

You can talk to your GP or asthma nurse about having the flu vaccination.  This usually happens in the autumn.  You can also talk to them about the pneumococcal vaccination which protects you from pneumococcal infection. The GP or practice nurse may/ may not give you your vaccinations if you are taking prednisolone at the time.

The respiratory syncytial virus (RSV) programme is available to all adults 75 years and over who have not previously received a single dose of RSV vaccine.

Who should have the COVID-19 vaccine

You may be offered a COVID-19 vaccine in if you:

are aged 75 or over

are aged 6 months to 74 years and have a weakened immune system because of a health condition or treatment

live in a care home for older adults

Speak to your local pharmacy, GP surgery or specialist if you're not sure if you're eligible for the COVID-19 vaccine.

Smoking can make asthma medicines less effective, increase the risk of an asthma attack and permanently damage your airways.  Stopping smoking can be difficult, but it will have a massive impact on your asthma.  You can ask your GP or asthma nurse for advice about smoking cessation services and nicotine replacement therapy.

People wanting to quit or find out more can contact:

Stoke on Trent: quitsmokingstoke.co.uk/sign-up

                                 0808 169 1869

Staffordshire: Staffordshire.everyonehealth.co.uk

                              0333 005 0095

                              Email: eh.staffs@nhs.net

                              Text: QUIT to 60777

Biologic treatments for asthma are specialized therapies aimed at patients with severe, uncontrolled asthma, typically initiated after confirming diagnosis, checking adherence to existing high-dose treatments, and identifying specific inflammatory markers (biomarkers).

Biologics can offer significant reductions in asthma attacks and steroid use by targeting specific inflammatory pathways (IgE, IL-5, or IL-4/IL-13).

The key criteria for accessing biologics generally involve demonstrating high disease burden and specific inflammatory phenotypes.

Key Eligibility Criteria

·         Severe Asthma Diagnosis: Patient must have severe, persistent asthma that is uncontrolled despite optimal high-dose inhaled corticosteroids (ICS) and long-acting beta-agonists (LABA).

·         High Exacerbation Rate: Frequent asthma attacks, usually defined as 3–4 or more within the past 12 months, requiring oral corticosteroid (OCS) tablets or emergency hospital visits.

·         OCS Dependence: Patients who are on continuous or regular long-term oral steroids.

·         Biomarker Profiles: Type 2 Inflammation (eosinophilic and allergic asthma) and non-type 2 inflammation normal level of eosinophils and biologic treatment for non-type 2 inflammation stops your airways reacting as much to triggers.

·         Allergic Asthma: Elevated IgE levels with positive skin/serum testing for perennial aeroallergens.

·         Eosinophilic Asthma: High blood eosinophil count.

·         FeNO Elevation: High fractional exhaled nitric oxide.

·         Comorbidities: Presence of type-2 related comorbidities such as chronic rhinosinusitis with nasal polyps (CRSwNP) or atopic dermatitis, which can be affected by the choice of biologic.

·         Adherence and Technique Check: Before approval, specialists must verify that the patient is taking their current medication correctly and has the correct inhaler technique.

·         Age and Other Conditions: Different biologics have age restrictions, usually 6+ or 12+ years old. Other comorbidities like nasal polyposis or atopic dermatitis can be key selection factors.

Biologics Available: Mepolizumab (Nucala), Benralizumab (Fasenra), Omalizumab (Xolair and Omlyclo), Dupilumab (Dupixent) Tezepelumab (Tezspire).

The effectiveness of Biologics: Significant reduction in exacerbations, improved quality of life, and steroid-sparing effects (reducing the need for oral corticosteroids).

Some common side effects (affecting up to 1 in 10 people) include:

·         Headache

·         Sinus pain

·         Sore throat

·         soreness at the injection site. This should go away in a few days and may improve after you’ve had the injection a few times.

·         Sometimes biologic treatments for asthma can increase the risk of a severe allergic reaction (anaphylaxis) for some people. The risk is rare (1 in 1000) and more likely if you have a history of allergic reactions or anaphylaxis.

Biologics are a specialist, targeted treatment. They are a ‘Add on treatment’ that are used in conjunction with your current asthma medication.

There are strict criteria for who can access them. You need to be referred to a specialist severe asthma service before you can be considered for biologic treatments. If you are suitable for your clinician will discuss your suitability and discuss the next steps which include a local multidisciplinary team meeting (MDT) and a regional Birmingham Regional Severe (MDT). The MDT meeting outcomes are made known either via a respiratory consultant or by clinical nurse specialist.

A Clinical Nurse Specialist (CNS) role in asthma biologics manages the care pathway for severe asthma patients, assessing eligibility, initiating treatment, and monitoring outcomes. They provide education on self-administration, monitor for adverse effects, and work within multidisciplinary teams (MDTs) to improve quality of life and reduce exacerbations.

Patient Assessment & Selection: Evaluate patients with severe asthma to determine eligibility for biologic therapies, reviewing blood tests, eosinophil counts, and asthma control levels.

Education & Support: Educate patients, families, and carers on asthma management, inhaler techniques, and the use of biologic medication which is supported with biologic patient information literature. Travel advice can also be provided.

Administration & Monitoring: Administer biologic via a sub-cut pre-filled injection in clinic, supervise self-administration training for home use, and conduct follow-up spirometry tests, eosinophil blood test and assessments to monitor treatment efficacy and safety.

Multidisciplinary Team Working (MDT): Collaborate with consultants, nurses, and pharmacists to manage patient care, including attending specialist MDT meetings and with the patient your General practitioner (GP).

Service Development & Audit: Participate in clinical audits, data submission to the National Asthma Audit Programme (NACAP), and developing protocols for the severe asthma service.

Pregnancy: If are planning a pregnancy or are currently pregnant and you’re using biologics or wish to be considered for biologic treatment you should speak with your specialists or midwife to be guided for more advice.

Improved Patient Outcomes: CNS roles are linked to reduced hospital admissions and better management of severe asthma through targeted therapies.

Our adult asthma service works with our paediatric service for patient’s established on biologics to streamline the patient care transitioning into our adult asthma services.