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Identifying Patients with Asthma on SABA alone

This project is likely to take:
<10 hours for the initial project (excluding re-audit)
<10 hours in total (including re-audit)

Can be done by a GP, Pharmacist, Trainee or Student

Green Impact for Health Toolkit area: Prescribing & Quality Improvement

CQC Areas

  • Wed-Led (Staff Development)
  • Effective (Improving Outcomes)
  • Safe (Safe System Pathways)

On this page

The benefits of this project

Project benefits for Your Patients

Benefits for Your Patients

  • Reduces risks related to undertreatment such as asthma attacks
Project benefits for Your Practice

Benefits for Your Practice

  • Improving safety of prescribing for this cohort of asthma patients.
  • Reduced workload through improved asthma control and hence reducing unscheduled care
Project benefits for The Planet

Benefits for The Planet

  • Well controlled asthma has 1/3rd of the carbon footprint of asthma that is uncontrolled

Opportunity for improvement

  • The 2024 BTS/NICE/SIGN asthma guidelines clearly state that short-acting beta2 agonists (SABA) should not be prescribed to people of any age with asthma without a concomitant prescription of an ICS.
  • In the past some people with asthma may have only been prescribed SABA treatment. Without an inhaled corticosteroid to treat the underlying inflammation, they are at increased risk of exacerbations. Identifying these patients and changing their treatment is essential to reducing this risk.
  • You might like to make a SMART goal for this project, e.g. text every patient with SABA-only prescriptions this month, inviting them to an 'Asthma Control Check' with our practice nurse.

How to carry out this project

  1. Patient Search

    Search for patients with a diagnosis of asthma who have been prescribed SABA inhaler in the last 12 months and no other inhaled therapy.

  2. Invite patients to an asthma review

    Prior to conducting the asthma reviews consider arranging an educational update for the team.

    The 2024 combined NICE/BTS/SIGN guidelines recommend that no patients with asthma should use SABA alone. For patients aged 12 years and over, the guidance recommends changing treatment for people with confirmed asthma who are currently using a short-acting beta2 agonist (SABA) only, to a low-dose ICS/formoterol combination inhaler used as needed reliever (AIR therapy). If asthma is uncontrolled then MART therapy (maintenance and reliever therapy) with combination ICS/formoterol inhalers is recommended.

    In children under 12 years of age first line therapy is separate low dose ICS and SABA inhalers. The guidance suggests considering paediatric low-dose MART (maintenance and reliever therapy) for children with asthma that is not controlled on paediatric low-dose ICS plus SABA as needed, as long as they are assessed to have the ability to manage a MART regimen.

    Resource: Text message

    We have identified that you are only prescribed a blue inhaler (salbutamol) to treat your asthma. Although salbutamol inhalers help to relieve symptoms, they do not treat the underlying cause of asthma. New combination inhalers are available to manage your asthma which are just as effective at managing symptoms and safer as they control the underlying swelling in the airways. Please book an appointment for an asthma review so that we can make your treatment safer. Watch this video for further information https://www.pcrs-uk.org/resource/asthma-myths-i-only-really-need-my-blue-inhaler.

  3. Identify non-responders

    Identify patients who have not responded to the invite within 6 weeks and consider alternative approaches to contact them.

    You may wish to add an alert to their notes so that this change can be made opportunistically.

  4. Study

    Measure the change has lasted e.g. 3-6 months and use the Project Monitoring form to keep track.

    Many practices run automatic searches at regular intervals – speak to your practice team about including this project in those searches.

Top tip

It has been common practice to prescribed SABA at the point of suspecting asthma or for mild asthma. You may need to repeat the guidance at several clinical meetings that there are no circumstances, in which prescribing SABA alone is recommended for people with asthma.

How to scale this project up or down

Please note - Use of this project requires NetworkPLUS membership. If you would like to share this project with others, please invite them to purchase their own membership—access must not be shared with non-members.

You could upscale this project by taking it to your PCN pharmacy team to implement across all practices in your PCN.  You could go wider and suggest the ICB medicines optimisation team includes it in a Pharmacy Quality Scheme. Use of this project requires a Greener Practice NetworkPLUS membership. If you would like to share this project with other organisations, please invite them to purchase their own membership—access must not be shared with non-members

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Tell us a little about your project and enter your data in order to generate a certificate showing the cost and carbon savings and other probable benefits. This project may help with CQC evidence submission (see disclaimers).

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