A new virtual severe asthma case-finding and remote triage service is being delivered for patients across Norfolk and Waveney ICS. 

Effective population-wide management of severe asthma (as defined by BTS guidelines) remains a significant challenge for local health systems. Delays in identification and referral, combined with long specialist waiting times, mean many patients are sub-optimally managed for extended periods. Across England, over 4,000 patients received more than four courses of oral steroids in the past year alone, yet only 17% have been initiated on guideline-recommended biologic therapy. With more than 7,000 patients nationwide estimated to have severe asthma, a more efficient approach to identifying, assessing, and referring this cohort is urgently needed. 

We are supporting primary care across Norfolk & Waveney by remotely reviewing, risk-stratifying, and directly engaging with patients. For those who consent, we will also manage the essential baseline testing (FeNO, spirometry, and blood eosinophils) and facilitate onward referral to specialist clinics for patients meeting the national severe asthma referral criteria. 

Patient education will be provided to all participants, and a comprehensive individual report will be sent to the GP upon completion of each review. No onward referral, prescribing decision, or patient contact will occur without the explicit prior consent of the GP. 

The aim of this project is to efficiently identify and manage patients with poorly controlled or sub-optimally treated severe asthma. It is led by the regional severe asthma specialist consultant service. 

Patient engagement will be delivered via the ECLIPSE interface (NHS Pathways). 

Eligible patients (see initial triage criteria below) will receive a text message through our patient engagement platform, PEGASUS (Patient Engagement Governance Assuring Standardised User Support). The message will direct them to the Norfolk & Waveney Asthma Review information zone, where they can access their patient portal, complete a questionnaire, and record their relevant medical history and personal preferences regarding participation in this project. 

Initial Triage Criteria 

Patients will be identified based on the following criteria: 

Diagnosis criteria: 

• Diagnosis of asthma or regular use of inhalers without a recorded diagnosis of respiratory disease 

Plus, any one of the following: 

• ≥ 1 emergency admission in the last 12 months (respiratory-related), or 

• ≥ 6 SABA prescriptions in the last 12 months, or 

• ≥ 3 courses of oral steroids (or recorded asthma exacerbations) in the last 12 months, or 

• Ongoing maintenance oral steroids ≥ 5mg daily 

Patients meeting these initial criteria will be contacted and further stratified according to regional MDT criteria (see flow diagram). 

The patient information zone also allows individuals with hearing or visual impairments to specify their accessibility preferences. It is equipped with translation services covering 20 of the most commonly spoken languages in the UK to ensure equity of access.