P68 Scope to improve asthma outcomes in primary care: outcomes of a community outreach programme

Introduction The National Review of Asthma Deaths England identified inadequate routine asthma care in over two thirds of patients and frequent sort-acting beta agonist (SABA) use was a marker of adverse outcomes. Correct inhaler technique and a personalised asthma action plan have been suggested as positive interventions. Novel biologic therapies are licensed for the management of severe eosinophilic asthma and improve outcomes for patients. We undertook a pilot outreach programme of multidisciplinary specialist asthma clinics in primary care. We present the key findings of this programme. Methods We undertook 7 clinics in 3 general practices between June and October 2019. Patients to be seen in these clinics were identified in primary care; suggested criteria were frequent SABA use (≥6 per year), recurrent courses of prednisolone or poor symptoms control. Each consultation encompassed asthma specialist nurse and consultant review in 3 stages: 1. spirometry, FeNO, symptom and QoL questionnaires, and prior asthma treatment review; 2. respiratory physician review; and 3. action plan and inhaler technique training. A standard dataset was collected, which included documentation of highest eosinophil levels in the preceding 12 months as well as exacerbations requiring prednisolone. Results 52 asthma patients participated in the programme (Table 1). 77% reported having had an asthma review in the past year with 67% reporting having had inhaler technique assessed and 21% having an asthma action plan. 58% had an eosinophil count (eos) recorded within the past year of whom 36% had eos ≥300cells/µL. Those with eos >300 cells/µL had numerically lower lung function and higher SABA and OCS use. 6 (12%) participants met NICE eos and exacerbation requirements for biologic therapy; however, none were on optimal therapy. Conclusion Despite being identified as having poor asthma control, patients may not have had simple interventions such as inhaler technique assessment done and may be unknown to specialist services. A proportion of these patients may be eligible for biologic treatment if they fail to improve on otherwise optimal therapy. A community outreach service may help in the identification and management of severe asthma patients.