Improving asthma diagnosis and care in South Yorkshire through FeNO testing

The challenge

Asthma remains significantly underdiagnosed, with around half of cases going unrecognised. This can lead to delayed or inappropriate treatment, poorer quality of life, avoidable exacerbations and increased hospital admissions. The burden is greatest in more deprived communities, where both incidence and mortality are higher and a large proportion of patients experience uncontrolled symptoms.

In South Yorkshire, partners identified an opportunity to improve early and accurate diagnosis, particularly for children and young people, while strengthening asthma management in primary care.

The approach

Health Innovation Yorkshire & Humber worked in partnership with five GP practices part of the Southey and Parson Cross Association Primary Care Network (PCN), Sheffield Children’s Hospital and South Yorkshire ICB to establish a community-based asthma clinic model.

We provided project management and evaluation services to support the efficient delivery of the project. We also drafted scientific abstracts in collaboration with our partners to disseminate the programme’s impacts at professional conferences.

The programme focused on embedding fractional exhaled nitric oxide (FeNO) testing – a NICE-recommended diagnostic tool – into routine general practice. Of the six GP practices part of the SAPA PCN, five were selected as initial test sites, serving a population of around 38,500 patients located in one of the most deprived areas nationally.

Clinicians were supported to use FeNO testing to improve diagnostic accuracy and guide evidence-based prescribing. Data was collected over a 12-month period to assess the impact on treatment decisions and referral patterns.

The results

The programme demonstrated clear improvements in both diagnosis and management:

• 218 patients assessed, including 62 children and young people
• 53 per cent of patients (115/218) had a change in medication following assessment
• Of patients not on definitive asthma treatment but with raised FeNO levels, 85 per cent (34/40) were started on inhaled corticosteroids
• Referrals to paediatric respiratory services reduced by 35 per cent

These findings show that integrating FeNO testing into primary care supports more accurate diagnosis and more appropriate treatment, reducing reliance on short-acting bronchodilators and aligning with national guidance.

It also helps to reduce the environmental impact of asthma care, where poorly controlled asthma and over-reliance on SABA inhalers contributes significantly to the carbon footprint.

The impact

This model is helping clinicians make more confident, evidence-based decisions, while improving access to diagnostics for patients in high-need communities.

By supporting earlier diagnosis and appropriate treatment, the programme has the potential to improve patient outcomes, reduce avoidable hospital activity and address health inequalities in asthma care.

It also demonstrates how a collaborative, system-wide approach can successfully embed innovation into routine practice and deliver measurable impact at scale.