Asthma, a prevalent long-term health condition, continues to face disparities in diagnosis and treatment, heavily influenced by geographical, socioeconomic, and ethnic factors. As World Asthma Day highlights these ongoing challenges, Carol Stonham MBE, a respected respiratory nurse, emphasizes the necessity of true accessibility in asthma care and why current efforts fall short.
The Postcode Lottery of Asthma Care
Asthma care varies significantly across different regions, with many patients experiencing a “postcode lottery” in access to essential services. Prompt and accurate diagnosis is critical for managing asthma effectively, yet disparities persist based on location and healthcare provider availability. Some areas lack access to the simple Fractional exhaled Nitric Oxide (FeNO) test, requiring patients to travel long distances for this straightforward procedure.
Recognizing that one-size-fits-all solutions are inadequate, healthcare systems are increasingly implementing neighborhood-based services. These are designed to tailor care to local community needs, ensuring that every patient receives appropriate and timely treatment.
Why FeNO Testing is a Game Changer
Asthma causes airway inflammation, which increases the production of nitric oxide (NO). The FeNO test measures NO levels in exhaled breath, providing a valuable tool for diagnosing asthma and guiding treatment decisions. Its clinical value has been recognized by the National Institute for Health and Care Excellence (NICE), the British Thoracic Society (BTS), and the Scottish Intercollegiate Guidelines Network (SIGN), all of which have updated their guidelines to include FeNO testing.
The test is quick, non-invasive, and easily integrated into a standard 10–15-minute consultation, making it an efficient addition to asthma management protocols.
Barriers Beyond Geography
Education plays a crucial role in asthma management for both healthcare professionals (HCPs) and patients. However, there is currently no standardized baseline for asthma training among HCPs, complicating efforts to recognize poor asthma control or adjust treatments effectively.
Informed HCPs can better educate patients, empowering them to manage their asthma and recognize when to seek help. Yet, access to care and information is not equal across the UK. Patients from lower socioeconomic backgrounds often face barriers to healthcare, including difficulties accessing reliable education or testing. Some may narrowly miss qualifying for free prescriptions, struggling with medication costs.
Cultural perceptions also play a role; in some ethnic communities, chronic illness is viewed as a weakness, underscoring the need for targeted education that resonates with underserved groups.
The Future Vision for Asthma Care
The most significant barrier to widespread FeNO testing is funding, specifically determining who is responsible for covering the costs. Inconsistent funding models mean that in some areas, the Integrated Care Board (ICB) provides support, while in others, the responsibility falls to the Primary Care Network (PCN). If the PCN does not prioritize FeNO testing, costs can fall to individual GP surgeries, leading to patchy and unreliable access.
A consistent, system-wide strategy is needed, with ICBs taking ownership to ensure funding for FeNO testing is available across regions. Without this, fully implementing the updated NICE, BTS, and SIGN guidelines remains impossible. Collaboration with advocacy organizations is crucial to build a strong case for the cost-effectiveness of FeNO testing.
Gloucestershire provides a successful example, where a local enhanced fee is paid for each diagnostic test, with payments reinvested to cover FeNO testing consumables. This model demonstrates how strategic funding can improve access and outcomes in asthma care.
Asthma care should not rely on guesswork, yet without the right tools, it risks becoming just that. Addressing these inequalities is essential for ensuring that all patients receive the care they need, regardless of their postcode or background.
About NObreath
The NObreath® is a FeNO device by Bedfont® Scientific Ltd., designed to measure airway inflammation for the management and diagnosis of asthma. The mission is to improve asthma diagnosis and management globally through accessible and cost-effective FeNO measuring devices.
