Asthma

BSc (Hons), MD, FRCP

Tom is a Consultant Respiratory Physician with specialist interest in severe asthma and complex breathlessness. He completed his undergraduate medical training at the University of Manchester and his postgraduate training in the Northwest, West Midlands and Merseyside deaneries.

MD, FRCP

David qualified in 1994 and has been a consultant involved in the care of patients with severe asthma since 2007. Dr Allen is also heavily involved in patient safety and improving quality of care through use of technology.

MD, MRCP

Dr Shruti Khurana is a Respiratory Consultant at Wythenshawe  Hospital with specialist expertise in severe asthma and biologic therapies. She is committed to delivering personalized, evidence-based care for patients with complex asthma and difficult-to-control airways disease.

PhD, MRCP

Dr Sarah Drake is a Respiratory Consultant specialising in severe asthma and airways disease. She completed a PhD focused on improving asthma diagnostics and has a strong interest in delivering accurate diagnoses and personalised, patient-centred treatment for individuals with severe asthma and complex airway conditions.

MD, FRCP

Stephen is a professor of respiratory medicine at the University of Manchester and honorary consultant physician at Manchester University NHS Foundation Trust. His clinical and research interests lie in the diagnosis, classification and management of airways disease, principally asthma and associated conditions such as inducible laryngeal obstruction and breathing pattern disorders.

BSc, MRes, PhD candidate

Leanne is a Consultant Nurse in Severe Asthma who leads with a strong focus on patient advocacy, working closely with individuals to support both the physical and psychological impact of their condition. She is committed to delivering high-quality, person-centred care and empowering patients through shared decision-making, while also contributing to national leadership and research in severe asthma.

MPharm, MSc, MRPharmC (Consultant)

Lynn is a Consultant Respiratory Pharmacist who specialises in severe asthma biologics and asthma treatment optimisation.

Kerry has worked within the severe asthma service for over 12 years and is a Clinical Nurse Specialist leading the Severe Asthma Nursing Team. She is also Joint Clinical Lead for the transition of young people from paediatric to adult services.

BSc(Hons), MCSP, Independent Prescriber

Reyenna is the Clinical Lead Physiotherapist for the Asthma and Airways services. Her specialist interests include assessment and management of disordered breathing patterns, severe asthma and complex breathlessness.

BSc, ClinPsyD

Hannah is a clinical psychologist, specialising in physical health, using an integrative approach, grounded in Cognitive Behavioural Therapy (CBT), Acceptance and Commitment Therapy (ACT) and solution focused therapy to support living well with long term conditions.

PhD

Gaël has created, developed and lead the bespoke sputum monitoring service for the last 30 years. She specialises in monitoring airway inflammation in chronic respiratory diseases and leads research in understanding sputum characteristics in patients with severe asthma, especially in response to biologics treatment.

New patients attend a specialist half-day assessment clinic led by our severe asthma team, including consultants, nurses, and therapists.

During your appointment, we will:

• review your asthma history and current symptoms
• review your medications and inhaler use
• carry out an examination
• arrange specialist tests such as spirometry, FeNO and blood tests

You may also be asked to complete questionnaires to help us understand how asthma affects your daily life.

After your assessment, the team will create a personalised treatment and management plan tailored to your needs.

This is our main follow-up clinic for patients with severe asthma.

We use these appointments to:

• review your asthma control
• monitor your symptoms and treatments
• support patients with stable asthma
• assess any worsening symptoms or flare-ups

If needed, we may discuss additional tests or treatment options to help improve your asthma control.

Some patients may be asked to book into this clinic when their asthma symptoms begin to worsen. The clinic  helps us better understand your type of asthma and identify what may be triggering your symptoms.

You may need to be seen if you notice:

• increased symptoms
• increased reliever inhaler use
• falling peak flow readings

During the appointment, we may carry out:

• an examination
• breathing tests
• blood tests and inflammation tests (biomarkers)

These results help guide treatment decisions with your asthma and may help us identify whether other conditions may also be contributing to your symptoms.

Please note: this clinic is not designed for severe asthma attacks requiring emergency treatment.

This clinic supports young people moving from children’s asthma services into adult care.

Our team provides additional support during this transition and helps young adults gain confidence in managing their asthma.

The clinic is led by severe asthma consultants and specialist nurses.

Pregnancy can sometimes affect asthma control, so regular review and support are important.

This clinic provides specialist care throughout your pregnancy to help keep your asthma well controlled and ensure you feel confident managing your symptoms.

We can:

• review your asthma regularly during pregnancy
• discuss the safety of asthma medications in pregnancy
• help you recognise worsening symptoms
• explain what to do if you develop an asthma attack

The clinic includes input from consultants, specialist nurses and pharmacists. When needed, we can also work with your obstetric and midwifery teams to provide joined-up care.

Using asthma medication regularly and correctly is an important part of keeping asthma under control.

In this clinic, our specialist pharmacist team can:

• review your medications
• discuss treatment options
• support inhaler use and treatment routines
• create a personalised treatment plan with you

We may also use specialist tools such as inhaler monitoring devices and FeNO testing to help assess how well treatments are working.

Patients starting biologic treatment will attend an initial assessment with a specialist nurse or pharmacist.

Biologic medicines are targeted treatments used for some types of severe asthma.

Treatment may be given:

• in clinic with support from our severe asthma nurses
• at home with support from a homecare nursing team

If suitable, patients can be trained to give injections themselves at home.

Patients on biologic therapies will also have an annual review to confirm treatment is helping improve your asthma control and reducing the need for steroid tablets.

Our specialist nurses provide focused asthma review appointments and personalised asthma action plans (PAAPs).

These clinics help patients:

• understand when asthma symptoms are worsening
• know when to seek medical help
• improve inhaler technique
• feel more confident managing their asthma

Our nurses can also provide training and support with inhaler use.

All patients are reviewed by our specialist physiotherapists during their initial assessment.

Further appointments may be offered to help with:

• breathing pattern disorders
• breathing control techniques
• sputum or mucus clearance
• Increasing physical activity and advice around exercise

Some patients may also benefit from specialist treatments or breathing devices designed to help clear mucus and improve breathing.

Living with severe asthma can affect emotional wellbeing as well as physical health.

Our specialist psychology team supports patients who may be experiencing:

• anxiety
• low mood or depression
• stress related to asthma
• difficulties managing treatment

The clinic provides support to help patients cope with living with a long-term respiratory condition and improve confidence in managing their health.

Spirometry is a simple breathing test that checks how well your lungs are working.

During the test, you will be asked to breathe into a mouthpiece connected to a machine called a spirometer. You may be asked to take a deep breath in and then blow out as hard and fast as you can.

The test helps us assess conditions such as:

• asthma
• chronic obstructive pulmonary disease (COPD)
• other lung conditions

Spirometry measures:

• how much air you can breathe out with force from your lungs (Forced vital capacity, FVC)
• how quickly you can empty your lungs in one second (Forced expiratory volume in one second, FEV1)

Peak flow is a quick breathing test that measures how fast you can blow air out of your lungs.

You will blow into a small handheld device called a peak flow meter.

This test can help us:

• monitor asthma control
• identify narrowing of the airways
• track changes in your breathing over time

FeNO is a simple breath test that measures inflammation in your airways.

During the test, you will breathe slowly into a mouthpiece.

Higher levels of nitric oxide can suggest inflammation linked to certain types of asthma. The results can help guide treatment decisions.

Blood tests can help us understand the type of asthma you have and whether allergies may be contributing to your symptoms.

These tests look for markers linked to inflammation and allergy activity in the body.

The results can help us:

• monitor asthma control
• guide treatment choices
• identify whether specialist treatments may help

We may review chest X-rays or other lung scans as part of your assessment.

These images can help identify signs of lung disease or other conditions that may be affecting your breathing.

The results help us develop a treatment plan tailored to your needs.

Sputum is mucus or phlegm coughed up from the lungs.

A sputum sample can help us look for:

• signs of airway inflammation
• infection
• different types of asthma

This test may be particularly useful when symptoms are worsening or during asthma flare-ups.

Inhalers are the main everyday treatment for asthma. They help reduce inflammation in the airways and make breathing easier.

Most people with asthma use:

• a preventer inhaler containing a steroid medicine to reduce inflammation
• a reliever inhaler to quickly ease symptoms when needed

Some inhalers contain a combination of medicines that both reduce inflammation and help open the airways.

There are many different inhaler devices available. During your clinic visits, our team will:

• review your inhalers and medications
• check your inhaler technique
• help you choose the most suitable inhaler for you

Using your inhalers correctly and regularly is an important part of keeping asthma well controlled.

Some patients may need extra treatments alongside their usual inhalers.

These may include:

• additional inhalers
• tablets
• other medicines to help improve asthma control

These treatments work in different ways to reduce inflammation, relax the airways and improve breathing.

Your treatment plan will be tailored to your individual needs.

Steroid tablets, such as prednisolone, are sometimes needed to treat asthma flare-ups.

These medicines are very effective at reducing inflammation in the lungs and can help improve symptoms quickly.

However, steroid tablets can cause side effects when used regularly over a long period of time. Because of this, our team carefully monitors patients who need frequent steroid treatment.

If you require regular steroid tablets, your consultant may discuss more advanced treatment options that could help reduce your need for steroids.

Biologic treatments are advanced medicines used for some types of severe asthma.

They work by targeting specific parts of the immune system linked to asthma inflammation. These treatments are more targeted than steroid tablets and may help improve asthma control while reducing the need for oral steroids.

Biologic treatments are only suitable for certain types of asthma. Our specialist team will discuss these treatments with you if they may be helpful for your condition.

Some biologic treatments can be given at home after appropriate training and support.

Before referring, primary or secondary care must confirm the diagnosis and rule out other medical conditions. The patient must meet at least one of the following criteria despite adherence to maximum inhaled therapies (high-dose ICS, LABA, and LAMA).:

• Frequent exacerbations: (e.g. 2 or more) courses of oral corticosteroids (OCS) or asthma-related hospital/A&E admissions in the past 12 months or one ICU admission
• Poor symptom control: Asthma Control Questionnaire (ACQ) score (>1.5) or Asthma Control Test (ACT) score (<20)
• SABA over-reliance: (e.g. 6 or more) short-acting bronchodilator (SABA) prescriptions in the previous 12 months.
• Maintenance OCS: Patients requiring continuous or frequent oral corticosteroids.

Referrals are triaged and will be rejected if the following has not been documented:

1. Adherence: Checked via primary care and hospital prescription records.
2. Inhaler Technique: Assessed, corrected, and documented.
3. Comorbidities: Treatment and optimization of concurrent conditions (e.g., chronic rhinosinusitis, inducible laryngeal obstruction, obesity, or anxiety).
4. Diagnostic Data: Inclusion of any recent (within 12 months) blood eosinophil counts, FeNO levels, and spirometry (dates of results must be included).

There is a link below to our referral proforma, this should be completed and attached to the referral letter.

The referral and proforma can be emailed to the severe asthma service on the email below. Only referrals from NHS emails will be accepted. GPs can refer via the NHS e-Referral Service (e-RS), please ensure all essential information is included.

• Referral Proforma
• Email: asthma@mft.nhs.uk