Summary

Asthma is a common health condition, affecting more than 5.4 million people in the UK. Around one in 12 adults and one in 11 children are currently receiving treatment for asthma. 6.5% of all people in England registered with a GP have a record of asthma.

Asthma has a huge impact on the lives of patients and leads to 60,000 hospital admissions each year. Severe asthma attacks can be potentially life-threatening and three people in the UK each day die of an asthma attack. (Source: British Lung Foundation)

However, many asthma attacks could be avoided through improvements to asthma care including early diagnosis, improved treatment, and self-management education. Asthma and respiratory disease are a key clinical priority for the NHS, as identified in the NHS Long Term Plan.

As a key partner of NHS England’s Accelerated Access Collaborative (AAC), the Health Innovation Network has supported the roll-out of Fractional exhaled Nitric Oxide (FeNO) testing as part of the AAC Rapid Uptake Products (RUP) programme.

Fractional exhaled Nitric Oxide (FeNO) testing

FeNO testing is a simple, non-invasive test to measure the amount of nitric oxide in an exhaled breath – a biomarker for airway inflammation. FeNO testing can improve patient care by contributing to a faster and more effective asthma diagnosis when used alongside a detailed clinical history and other tests. It can also be used to monitor patient response to asthma treatments. The test takes seconds to perform and gives a result almost immediately, resulting in more people ending up on the right treatment for the right condition, with less waste of medicines.

As FeNO had a lower-than-expected uptake, it presented an opportunity to improve patient access by embedding FeNO testing in primary care. FeNO was part of the AAC’s Rapid Uptake Products programme, with AHSNs providing spread and adoption support from April 2021 to March 2023.

Led by Wessex AHSN, the programme focused on collaboration at a national, regional and local level across healthcare systems, industry partners, patients, and the community and voluntary sector to integrate FeNO testing into everyday clinical practice.

AHSNs worked within their individual systems to support asthma pathway improvements by taking a pathway-based transformation approach. AHSNs provided clinical and transformation leadership, shared best practice, and developed education and implementation materials for those involved in providing asthma care.

A package of educational resources for FeNO, including information documents, podcasts, posters, learning modules and webinars, was created to support clinicians. The toolkits were designed in a practical way to support teams adopting and sustaining the use of FeNO.

The FeNO programme also worked collaboratively with the AHSN Asthma Biologics programme which aimed to improve access to innovative biological therapies.

Outcomes

The FeNO programme aimed to improve patient care and outcomes through enhanced access to diagnostics. Key impacts include:

  • More than 1,200 new FeNO devices in use in primary care.
  • An estimated 53% of Primary Care Networks (PCNs) in England now have access to FeNO testing.
  • FeNO has supported the correct diagnosis of an estimated 58,000 new asthmatics faster and more accurately.
  • 33 Pathway Transformation Fund projects were completed to support wider adoption FeNO.

For the clinical workforce delivering asthma care the FeNO programme has supported learning, training and development.

  • Two FeNO training modules resulted in more than 4,900 hours of training being completed with 91% of those using the training saying it will help them in their role.
  • 722 people joined the national learning collaborative series.
  • The FeNO implementation toolkit was accessed more than 13,500 times.

Next steps

The national FeNO programme has now completed and has made substantial contributions to the transformation of asthma care in England while significantly increasing the access to and adoption of FeNO. Learning from the FeNO and Asthma Biologics AHSN programmes is being fed into the development of NICE/SIGN/British Thoracic Society asthma guidance, expected in 2024, offering real world insights to implementation considerations.

There are opportunities to continue this work and improve asthma care by enhancing rollout of the innovations and ensure more patients can benefit. The FeNO toolkits, training modules and other resources created during the programme will remain accessible to NHS clinicians following the end of the AHSN programme.

The Health Innovation Network is transitioning to support healthcare inequalities as a national priority as part of NHS England’s Innovation for Healthcare Inequalities Programme (InHIP). Building on the transforming asthma pathways work, a number of AHSNs will support the respiratory aspect of the NHS England Core20PLUS5 approach, continuing to utilise the implementation and educational resources developed for the FeNO national programme.

Summary of resources

Below, you will find information collated to help you learn more about this programme’s aims, impact, and wider context, including evidence and information to support your implementation.

The resources have been selected for the benefit of health and care professionals. Some information links out to third party sources, and the Health Innovation Network is not responsible for the content on those sites.

National enquiry

To find out more about any of our national programmes, please complete this form.

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