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New NHS collaboration supports optimisation of asthma management

Posted: 16th November 2021

We are working with the NHS in Hull and AstraZeneca on a new project that aims to deliver improvements in care for thousands of people with uncontrolled asthma and reduce the associated carbon footprint. The SENTINEL programme aims to optimise the use of anti-inflammatory ‘preventer’ inhalers, which treat the underlying inflammation of asthma, while reducing the reliance on and prescribing of blue ‘reliever’ inhalers and the greenhouse gas emissions they produce. At the programmes’ core are the implementation of local asthma guidelines, delivery of targeted patient reviews, and provision of education packaged to clinicians and patients.

Early data from the first PCN in Hull shows a reduction in SABA* inhaler use, moving from a PCN with one of the highest uses nationally (98th percentile) to below the national average (41st percentile) in under four months. Changes in prescribing has reduced the number of blue inhalers used by nearly 7,000 units, equating to an offset of over 195,000 kg in CO2 emissions – in under six months and from just two PCNs. These initial findings highlight the potential opportunity to change aspects of respiratory care in other parts of the UK to support the delivery of asthma policies within the NHS Long term Plan and Greener NHS Strategy.

Dr Mike Crooks, Consultant Respiratory Physician “Over-reliance on blue ‘reliever’ medication contributes to poorer health outcomes and potentially avoidable emergency admissions. We hope healthcare professionals in Primary Care Networks will look at what we’re doing here in Hull and see the benefits it brings to both patients and the health system. We are hopeful of delivering long-term patient outcomes as well as the added benefit of reducing our carbon footprint. It has been clear that we need to help people living with asthma recognise what over-reliance on reliever inhalers is and to seek out an asthma review from their GP, nurse or pharmacist”

In the UK, anti-inflammatory inhalers are under-used in asthma while almost 2 in 5 patients are potentially over-reliant on their blue inhalers (prescribed three or more inhalers in a year). Patients who are over-reliant on their blue inhalers have twice as many asthma attacks compared to those who don’t, regardless of their asthma severity.

The SENTINEL programme, is currently running across six primary care networks (PCNs) in Hull and East Riding, a region with 40,000 asthma patients and some of the highest rates of reliever inhaler over-reliance in the country.

Harriet Smith, Yorkshire and Humber AHSN said “We are proud to be able to support this programme which provides benefits to both the patient and the healthcare system. The AHSN is committed to finding new innovations that will improve health outcomes and we act as a bridge between the NHS, industry and academia to encourage the adoption and spread of improved services at scale. We are therefore delighted with the results seen by our partners in Hull and we will be working to support further adoption of this programme across other parts of the region to help reduce the reliance on reliever inhalers.”

Tom Keith Roach, President, AstraZeneca UK, said  “Eliminating asthma attacks wherever possible should be a priority in improving asthma care in the UK. The encouraging results we’ve seen in Hull and Yorkshire show a path forward in making the changes needed to reduce over-reliance on SABA medication, which we know is putting patients at increased risk of asthma attacks. SENTINEL is a true collaboration between AstraZeneca, academia and the National Health Service that can be scaled nationally to implement much-needed change, which we hope will improve patient outcomes and simultaneously optimise healthcare utilisation.”

Our role as an AHSN is to ensure innovative solutions like this are adopted and spread widely across the NHS. If you would like more information about this project, please email

For more information on the quality improvement initiative undertaken in Hull and East Yorkshire in joint collaboration with AstraZeneca, please visit