Rapid Uptake Products (RUP)
The Accelerated Access Collaborative (AAC) is the umbrella organisation for UK health innovation. It supports the NHS to quickly adopt proven and cost-effective innovations, and to ensure patients get access to the best new treatments and technologies. It does this through the Rapid Uptake Products (RUP) programme. This programme delivers bespoke support initiatives to increase system wide uptake and spread.
Asthma
Asthma is a long-term condition that affects your airways – the tubes that carry air in and out of your lungs. It usually causes symptoms such as coughing, wheezing and breathlessness. If someone with asthma comes into contact with an asthma trigger, it can make symptoms worse and even bring on an asthma attack.
Asthma accounts for 2-3% of primary care consultations. It impacts on everyday life such as education and work, leads to 60,000 hospital admissions and 200,000 bed days per year in the UK. Asthma attacks kill three people in the UK each day and every 10 seconds someone has a potentially life-threatening asthma attack. However, many of these severe attacks and deaths could be avoided by taking simple measures to improve care. The key challenges for the health system with regards to asthma are early diagnosis, correct treatment and good education to enable self-management.
Severe asthma
Severe asthma is a type of asthma that cannot be controlled with regular
asthma treatments, such as inhaled steroids and long-term bronchodilators,
despite good adherence to treatment and optimised inhaler technique. More than 100,000 people in the UK may have
severe asthma, which, if uncontrolled, puts them at risk of poorer health
outcomes and often severely impacting their quality of life.
About biological therapies
Biological, or biologic, therapies are a type of medicine called monoclonal antibodies,
and work in a different way to other asthma treatments. They may be offered to people with severe
asthma, and can improve symptoms and reduce asthma attacks by helping to stop
the body processes that cause lung inflammation.
NICE has published several evidence-based recommendations around the use
of biological treatments as an option for treating severe asthma in patients
who meet certain criteria:
·
Omalizumab is for people with
severe allergic asthma. It targets immunoglobulinE (IgE), a chemical found in
the bloodstream. IgE is produced in
response to environmental allergens such as house dust mites, pollen and
moulds, which can act as triggers for allergic asthma symptoms.
NICE have published technology appraisal guidance for three different
therapies used in the treatment of severe eosinophilic asthma:
·
Benralizumab targets and depletes
the immune cells (eosinophils) in the body which cause severe asthma, and can
reduce the inflammation that leads to asthma symptoms and asthma attacks.
·
Mepolizumab is another biological
treatment for severe eosinophilic asthma which work by reducing the number and
activity of eosinophils in the blood
·
Reslizumab similarly inhibits
interleukin‑5 to reduce eosinophils and lower inflammation during an allergic
reaction
These treatments can only be prescribed from Specialist Asthma Centres,
following a confirmed diagnosis of severe asthma and discussion at a
multidisciplinary team meeting.
Examples of transformation projects
Local projects
Developing the role of the Biologics Pathway Co-ordinator
University Hospital Southampton NHS Foundation Trust hopes to improve
asthma care within their expanding service by developing the role of a
dedicated Patient Co-ordinator within their asthma biologics pathway. As well as reducing duplication and delay,
this role hopes to free up members of the clinical team so that more time can
be dedicated to their clinical commitments.
Community-based specialist respiratory nurses for patient identification
NHS Dorset CCG plans to use their regional data service (Dorset Insights and Intelligence Service) to identify patients potentially suffering from severe asthma at a PCN level. Community-based specialist respiratory nurses will then be able to review identified patients, prior to considering referral to secondary care for further diagnosis and, where appropriate, treatment with asthma biologics.
Resources
Asthma Biologics Toolkit- this includes a number of resources for clinicians including guidance, webinars, podcasts and the newly launched patient information leaflets in a variety of languages
Advice and support for the public can be found at:
NHS UK https://www.nhs.uk/conditions/asthma/
Asthma UK https://www.asthma.org.uk/ 0300 222 5800
Allergy UK https://www.allergyuk.org/ 0132 261 9898
Action Against Allergy https://actionagainstallergy.org/ 0208 892 2711
British Lung Foundation https://www.blf.org.uk/ 0300 003 0555
Wessex AHSN is not responsible for the quality or accuracy of any
information or advice provided by these organisations.
REFERENCES:
1. Price D et al, NPJ Prim Care Respir Med 2014; 12(24): 14009
2. Fernandes AG et al, J Bras Pneumol 2014; 40(4): 364-372
3. Pieter-Paul W et al, J Allergy Clin Immunol 2015; 135(4): 896-902
