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Breaking down barriers for better asthma care

Posted: - 26th January 2023

A collaboration between the NHS and AstraZeneca has revolutionised the care of asthmatic patients delivering improvements in care for thousands of people with uncontrolled asthma and reducing the associated carbon footprint.

Asthma is common in the UK, with approximately five million people suffering from the condition. Although we have seen advances in treatment, health outcomes associated with asthma have stagnated, and as a country, we now have some of the worst outcomes in Europe. The key to treating asthma is to control the airway inflammation using inhalers that contain a steroid.

This kind of inhaler is often called a ‘preventer’ and needs to be taken every day. Many people with asthma also have a ‘blue’ inhaler that they use as a ‘reliever’. These inhalers relax the muscle around the airways in the lung, temporarily reducing symptoms. Unfortunately, these blue inhalers (known as SABAs) do not treat the inflammation, they only provide short term benefit. Hull is a region with some of the highest SABA inhaler use in the country.

In a bid to try and manage this and improve the health of asthma patients within the Hull region, Dr Michael Crooks (Respiratory Consultant and Senior Lecturer) and colleagues at Hull University Teaching Hospitals NHS Trust, Hull York Medical School and what was at the time Hull Clinical Commissioning Group (CCG), started working in collaboration with a team at AstraZeneca. Together they worked with asthma clinicians and patients using experience-based co-design methodology to develop a programme to promote good quality asthma care through implementation of local asthma guidelines. At the same time, the team have been undertaking a rigorous evaluation and generating real-world evidence to ensure that lessons are learned, and good practice is shared.

What they came up with is an award-winning programme called SENTINEL Plus, to support and empower clinicians and patients to improve asthma care. This programme has the following five components: healthcare professional education, implementation of ‘gold standard’ prescribing practices, targeted reviews for asthma patients who are over-using SABA, patient education and support, and real-time data monitoring and reporting of asthma care metrics

How we helped

We have played an instrumental part in SENTINEL Plus becoming part of the Accelerated Access Collaborative (AAC) Rapid Uptake Products (RUP)programme and supporting its adoption across PCNs in Hull and East Riding – a region with 40,000 asthma patients and some of the highest rates of blue inhaler use in the country.


There are now 305 PCN’s signed up to SENTINEL PLUS throughout England, with interest being shown in Scotland and France.

From November 2020 to April 2022 changes in prescribing has reduced the number of blue inhalers used by nearly 25,924 units, equating to an offset of 725 metric tonnes in CO2 emissions which is equivalent to 907 transatlantic flights from Leeds to New York. 2,948 patients have been reviewed across six Primary Care Networks (PCNs) in Hull and East Riding.

Find out more about SENTINEL Plus

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I genuinely think that the AHSN’s involvement has been great for SENTINEL and will continue to be. The reach and impact that the webinars had, the HSJ awards and the potential to have SENTINEL adopted as a Rapid Uptake Product wouldn’t be possible without their involvement. I think that supporting adoption within regions has been really valuable because one of the key drivers to sustained change is persistent and consistent messaging, and reaching as many people across the care pathway as possible. I think the partnership approach really has added value.

Dr Michael Crooks, Respiratory Consultant and Senior Lecturer, Hull University Teaching Hospitals NHS Trust and Hull York Medical School

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