A local treatment route for severe asthma biologics in Brighton, UK, is bringing significant benefits to patients, staff and the wider NHS. Eight months on from the launch of this new service, Dr Harpreet Ranu discusses its positive impact on accessibility of care, improved patient outcomes and cost savings, as well as looking to the future of the service.
Historically, adults with severe asthma in Brighton and the Sussex area faced an inconvenient four-hour round trip to the severe asthma centre at the Royal Brompton Hospital in London for assessment and potential biologic therapy – a feat easier said than done when experiencing an exacerbation.
The opening of the Louisa Martindale Building at Royal Sussex County Hospital in Brighton in May 2023 paved the way for much needed change. A new respiratory ward and Same Day Emergency Care (SDEC) unit enabled the severe asthma team to develop a local service to ensure eligible patients receive life-changing biologic therapies close to home.
Launched in February 2024, the service involves multidisciplinary assessment from a specialist nurse, a physiotherapist and a consultant in respiratory medicine – Dr Harpreet Ranu, who is also the severe adult asthma lead.
This assessment then gets fed into a monthly virtual multidisciplinary team (MDT) meeting with their colleagues at the Royal Brompton Hospital’s severe asthma centre before deciding whether the patient is suitable for asthma biologics.
‘It means those patients can be started on the treatment locally, usually within a few weeks, sometimes even a few days,’ says Dr Ranu. Once set up on their treatment regimen, some patients are even able to self-inject, meaning they can administer it from the comfort of their own home.
This is a stark contrast to the previous system that would involve up to two years of waiting with repeated visits to Brighton and London before a treatment decision could be made and biologic injections at the specialist centre could begin.
Improving accessibility, enhancing severe asthma outcomes
In breaking down this barrier to timely and effective treatment, Dr Ranu and her colleagues have seen significant improvements in patient outcomes in just the few months since the service launched.
‘Severe asthma for a patient essentially means they’re having recurrent exacerbations of their asthma, where they’re requiring three or more courses of oral steroids with a 12-month period, which can have significant side effects,’ says Dr Ranu. ‘They may also require hospital admissions, including an intensive care admission if they’re unwell, and this has a significant implication in terms of their physical health, but also in terms of their mental health and time off work.’
In contrast, the minimally invasive biologic injections are thought to have little to no side effects and Dr Ranu says they can lead to a reduction in exacerbations by as much as 50%.
‘I’ve had some patients say that they feel like they’ve got the life back – they can go to work, they can do things they enjoy,’ Dr Ranu explains. ‘Certainly, for one patient, he is now able to play with his grandchildren, so it’s really heartening to hear these responses from patients that we’ve seen and looked after who’ve been so unwell.’
The feedback from patients about the service itself and the continuity of care it offers has been very positive, too. ‘Certainly, patients are very relieved to know they don’t need to travel to London for this treatment, and they can come to the local hospital and see healthcare professionals that have been involved in their care,’ Dr Ranu adds.
Multidisciplinary effort for severe asthma
The buy-in from this local team of healthcare professionals is one of the key reasons for the service implementation being possible – and for its success, according to Dr Ranu.
‘We have a very experienced asthma specialist nurse, Jenny Beaumont, and myself, and we also have asthma physiotherapists and an asthma MDT coordinator,’ she explains. ‘These are key parts of the service to make sure the pathway for these patients and the timeline are as short as possible, but also to make sure that we look at the patients holistically.’
And the MDT input doesn’t end there as the service requires support from the hospital’s divisional and operational teams, the wider respiratory department to free up space and staff, and virtual support from the severe asthma centre.
‘With all new services, it obviously involves additional work and developing competencies – mainly around assessing patients on SDEC, close monitoring of patients on biologics and day-to-day administration of the service including entry to Severe Asthma Registry. Having the support from our colleagues at the Royal Brompton is invaluable,’ Dr Ranu adds.
This collaborative effort means increasingly more patients are able to enjoy timely and efficient access to these biologic injections – along with the subsequent improved quality of life – and the apparent scope is significant.
Nearly 130 asthma patients have been seen in the respiratory SDEC unit and 40 patients have been started on biologics so far. But, as Dr Ranu explains, ‘if we look at the potential number of patients that could be suitable for asthma biologics within the Sussex area alone, this could be as high as 1,300 patients’.
Supporting the wider health economy
Having the potential to improve the lives of so many people with severe asthma is significant, but Dr Ranu is keen to point out the positive impact on the wider health economy, too.
‘In terms of this treatment, there are significant savings to be made. If you look at the modelling, the potential cumulative savings over a five-year period could be as high as £2m. And that may be a conservative estimate,’ Dr Ranu says.
But that’s not all. Asthma is estimated to cost the UK public sector at least £1.1bn every year and is responsible for over six million primary care consultations, 100,000 hospital admissions and the loss of 17 million working days annually.
With the NHS currently working at – and beyond – its limits, this new service is one of the many ways in which efficiencies can be made and pressure can be relieved. Reducing GP visits, A&E attendances, hospital admissions and the need for mental health provision are all possible and have wide-reaching benefits for the staff, system and patients involved.
The potential for expansion
With the cost savings and value for all stakeholders speaking for themselves, funding for the continuation of the service is a top priority for Dr Ranu.
‘The funding is currently fixed for a period of time, and that will run out in 2025, so it’s ensuring that we have long-term funding to continue to deliver this for patients that we know are out there and need biologic treatment,’ she says.
Another priority that will contribute to future funding discussions is around expanding the scope of the service beyond its current secondary care remit.
‘Looking at the percentage of patients with severe asthma, if you look at various studies, it may be 3.8% of patients have asthma coding in primary care, but it may even be as high as 8%,’ Dr Ranu says. ‘We would hope to work with our colleagues in primary care to essentially find patients and bring them through the system to shorten their treatment pathway.’
How the severe asthma service continues to develop will also be dependent on the different asthma biologics that are going through clinical trials.
‘Currently, most of the asthma biologics are delivered either two- or four-weekly, or there’s one that’s delivered eight-weekly,’ Dr Ranu explains. ‘But, moving forward, there may be ones that could be delivered on a six-monthly basis, which, again, will have a significant positive impact for patients.’
