Asked by: Jim Shannon (Democratic Unionist Party - Strangford)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health and Social Care, with reference to the guidance from the NHS Accelerated Access Collaborative, whether his Department is taking steps to minimise the use of Oral Corticosteroids as a maintenance treatment for asthma patients.
Answered by Will Quince
There are no plans to undertake an assessment of the prescribing of oral corticosteroids for asthma and chronic obstructive pulmonary disease (COPD). Reducing health inequalities amongst people with COPD and asthma is a key cross-cutting focus for NHS England. Respiratory clinical networks have been established to support delivery of the objectives set out in the Long-Term Plan, which includes a particular focus on reducing health inequalities.
National Institute for Health and Care Excellence (NICE) and the British Thoracic Society and the Scottish Intercollegiate Guidelines Network provide clear guidance on the prescribing of oral steroids for both COPD and asthma. For both conditions, short courses only are recommended in cases of acute exacerbations.
For people with COPD, NICE do not normally recommend maintenance use of oral corticosteroid therapy. However, some people with advanced COPD may require maintenance oral corticosteroids when these cannot be withdrawn after an exacerbation. In these cases, the dose of oral corticosteroids should be kept as low as possible.
Asked by: Jim Shannon (Democratic Unionist Party - Strangford)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health and Social Care, whether it his Department's policy to reduce the use of oral corticosteroids as a maintenance treatment for asthma in the context of the Major Conditions Strategy’s focus on chronic respiratory diseases.
Answered by Helen Whately - Minister of State (Department of Health and Social Care)
The Strategy will cover treatment and prevention for chronic respiratory disease and the Department will continue to work closely with stakeholders, citizens and the National Health Service in the coming weeks to identify actions that will have the most impact. The Strategy will also apply a geographical lens to address regional disparities in health outcomes, supporting the levelling up mission to narrow the gap by 2030.
Asked by: Jim Shannon (Democratic Unionist Party - Strangford)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health and Social Care, whether his Department has plans to issue guidance on reducing the use of oral corticosteroids in treating asthma and COPD.
Answered by Gillian Keegan - Secretary of State for Education
While the National Institute of Health and Care Excellence’s (NICE) guideline ‘Asthma: diagnosis, monitoring and chronic asthma management’ does not specifically make recommendations on oral corticosteroids, NICE is working with the British Thoracic Society and the Scottish Intercollegiate Guidelines Network to produce United Kingdom-wide guidance to update and replace this guideline. Evidence on pharmacological management, including the use of oral corticosteroids, will be reviewed during this process.
The 2022/23 Quality and Outcomes Framework incentivises general practitioners to assess asthma control through a questionnaire, which records of the number of exacerbations, an assessment of inhaler technique and a written personalised action plan, to monitor potential over-prescribing. The Impact and Investment Fund currently contains two indicators which aim to improve the care of people with asthma, including recognising Primary Care Networks which reduce in the percentage of patients receiving six or more Short-Acting Beta Agonists (SABAs) prescriptions per year.
NICE’s guidelines for asthma and its guideline ‘Chronic obstructive pulmonary disease in over 16s: diagnosis and management’ recommend oral corticosteroids and alternatives. For adults with asthma, these include SABAs, leukotriene receptor antagonists and long-acting beta2 agonists. For chronic obstructive pulmonary disease (COPD), NICE recommends smoking cessation, SABAs and short-acting muscarinic antagonists, Theophylline tablets, oral mucolytic therapy, oral anti-oxidant therapy, oral anti-tussive therapy, oral prophylactic antibiotic therapy, long-term oxygen therapy, ambulatory oxygen therapy, short-burst oxygen therapy, non-invasive ventilation and pulmonary rehabilitation. NICE has also published technology appraisal guidance on biologics for those with severe asthma, such as Omalizumab for treating severe persistent allergic asthma.
No specific assessment has been made of the cost of caring for and treating adverse events in patients prescribed frequent or maintenance prescriptions of oral corticosteroids. However, in developing its guidelines, NICE has recommended a number of medicines for patients with severe asthma, such as mepolizumab, which considered the costs and benefits relating to a potential reduction in the use of corticosteroids.
NHS England and NHS Improvement’s Severe Asthma Collaborative is developing capacity in severe asthma centres to streamline patient pathways to biologic therapies and reduce variation in prescribing and patient management. A toolkit has been produced to support clinical teams.
The Royal College of General Practitioners’ guidance on long term condition recovery asks clinicians to consider all high-risk patients with COPD and asthma who have not received a review for more than 12 months and have been prescribed either three or more SABAs in the last 12 months; those aged five years old and over not on the asthma or COPD register who have received two or more courses of oral steroids in 12 months; and those on the asthma or COPD register to be prioritised for review.
Asked by: Yvonne Fovargue (Labour - Makerfield)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health and Social Care, what alternatives to oral corticosteroids treatment are available for asthma and COPD patients.
Answered by Gillian Keegan - Secretary of State for Education
While the National Institute of Health and Care Excellence’s (NICE) guideline ‘Asthma: diagnosis, monitoring and chronic asthma management’ does not specifically make recommendations on oral corticosteroids, NICE is working with the British Thoracic Society and the Scottish Intercollegiate Guidelines Network to produce United Kingdom-wide guidance to update and replace this guideline. Evidence on pharmacological management, including the use of oral corticosteroids, will be reviewed during this process.
The 2022/23 Quality and Outcomes Framework incentivises general practitioners to assess asthma control through a questionnaire, which records of the number of exacerbations, an assessment of inhaler technique and a written personalised action plan, to monitor potential over-prescribing. The Impact and Investment Fund currently contains two indicators which aim to improve the care of people with asthma, including recognising Primary Care Networks which reduce in the percentage of patients receiving six or more Short-Acting Beta Agonists (SABAs) prescriptions per year.
NICE’s guidelines for asthma and its guideline ‘Chronic obstructive pulmonary disease in over 16s: diagnosis and management’ recommend oral corticosteroids and alternatives. For adults with asthma, these include SABAs, leukotriene receptor antagonists and long-acting beta2 agonists. For chronic obstructive pulmonary disease (COPD), NICE recommends smoking cessation, SABAs and short-acting muscarinic antagonists, Theophylline tablets, oral mucolytic therapy, oral anti-oxidant therapy, oral anti-tussive therapy, oral prophylactic antibiotic therapy, long-term oxygen therapy, ambulatory oxygen therapy, short-burst oxygen therapy, non-invasive ventilation and pulmonary rehabilitation. NICE has also published technology appraisal guidance on biologics for those with severe asthma, such as Omalizumab for treating severe persistent allergic asthma.
No specific assessment has been made of the cost of caring for and treating adverse events in patients prescribed frequent or maintenance prescriptions of oral corticosteroids. However, in developing its guidelines, NICE has recommended a number of medicines for patients with severe asthma, such as mepolizumab, which considered the costs and benefits relating to a potential reduction in the use of corticosteroids.
NHS England and NHS Improvement’s Severe Asthma Collaborative is developing capacity in severe asthma centres to streamline patient pathways to biologic therapies and reduce variation in prescribing and patient management. A toolkit has been produced to support clinical teams.
The Royal College of General Practitioners’ guidance on long term condition recovery asks clinicians to consider all high-risk patients with COPD and asthma who have not received a review for more than 12 months and have been prescribed either three or more SABAs in the last 12 months; those aged five years old and over not on the asthma or COPD register who have received two or more courses of oral steroids in 12 months; and those on the asthma or COPD register to be prioritised for review.
Asked by: Yvonne Fovargue (Labour - Makerfield)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health and Social Care, if his Department will make recurrent oral corticosteroids prescriptions from primary care a trigger for referral to secondary or tertiary care for asthma patients.
Answered by Gillian Keegan - Secretary of State for Education
While the National Institute of Health and Care Excellence’s (NICE) guideline ‘Asthma: diagnosis, monitoring and chronic asthma management’ does not specifically make recommendations on oral corticosteroids, NICE is working with the British Thoracic Society and the Scottish Intercollegiate Guidelines Network to produce United Kingdom-wide guidance to update and replace this guideline. Evidence on pharmacological management, including the use of oral corticosteroids, will be reviewed during this process.
The 2022/23 Quality and Outcomes Framework incentivises general practitioners to assess asthma control through a questionnaire, which records of the number of exacerbations, an assessment of inhaler technique and a written personalised action plan, to monitor potential over-prescribing. The Impact and Investment Fund currently contains two indicators which aim to improve the care of people with asthma, including recognising Primary Care Networks which reduce in the percentage of patients receiving six or more Short-Acting Beta Agonists (SABAs) prescriptions per year.
NICE’s guidelines for asthma and its guideline ‘Chronic obstructive pulmonary disease in over 16s: diagnosis and management’ recommend oral corticosteroids and alternatives. For adults with asthma, these include SABAs, leukotriene receptor antagonists and long-acting beta2 agonists. For chronic obstructive pulmonary disease (COPD), NICE recommends smoking cessation, SABAs and short-acting muscarinic antagonists, Theophylline tablets, oral mucolytic therapy, oral anti-oxidant therapy, oral anti-tussive therapy, oral prophylactic antibiotic therapy, long-term oxygen therapy, ambulatory oxygen therapy, short-burst oxygen therapy, non-invasive ventilation and pulmonary rehabilitation. NICE has also published technology appraisal guidance on biologics for those with severe asthma, such as Omalizumab for treating severe persistent allergic asthma.
No specific assessment has been made of the cost of caring for and treating adverse events in patients prescribed frequent or maintenance prescriptions of oral corticosteroids. However, in developing its guidelines, NICE has recommended a number of medicines for patients with severe asthma, such as mepolizumab, which considered the costs and benefits relating to a potential reduction in the use of corticosteroids.
NHS England and NHS Improvement’s Severe Asthma Collaborative is developing capacity in severe asthma centres to streamline patient pathways to biologic therapies and reduce variation in prescribing and patient management. A toolkit has been produced to support clinical teams.
The Royal College of General Practitioners’ guidance on long term condition recovery asks clinicians to consider all high-risk patients with COPD and asthma who have not received a review for more than 12 months and have been prescribed either three or more SABAs in the last 12 months; those aged five years old and over not on the asthma or COPD register who have received two or more courses of oral steroids in 12 months; and those on the asthma or COPD register to be prioritised for review.
Asked by: Jim Shannon (Democratic Unionist Party - Strangford)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health and Social Care, how many and what proportion patients with asthma who require three or more courses of oral corticosteroid each year do not receive care from a specialist asthma service.
Answered by Gillian Keegan - Secretary of State for Education
No specific estimate has been made. NHS England and NHS Improvement’s Severe Asthma Collaborative is developing the capacity of the severe asthma centres to streamline patient pathways to biologic therapy and reduce variation in prescribing and patient management, with a toolkit produced to support clinical teams. The Accelerated Access Collaborative is supporting the increased uptake of biologic therapy through the improved identification of patients with potential severe asthma in primary and secondary care and enable patient referrals to severe asthma centres to determine eligibility.
The information requested on the number and proportion of patients with asthma who require three or more courses of oral corticosteroid each year do not receive care from a specialist asthma service is not held centrally.
Asked by: Yvonne Fovargue (Labour - Makerfield)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health and Social Care, what plans are in place to introduce NHS system incentives to reduce over-prescribing of oral corticosteroid for asthma and severe asthma.
Answered by Jo Churchill - Minister of State (Department for Work and Pensions)
NHS England and NHS Improvement are considering the feasibility of introducing system incentives to increase appropriate prescribing of inhaled corticosteroid inhalers and to improve the prescribing of short-acting beta-agonists inhalers. The aim will be to improve patient outcomes but also reduce carbon emissions.
An update to the General Practitioner Contract for 2020/21 to 2023/24 includes an improved Quality Outcome Framework asthma domain. This incorporates aspects of care positively associated with better patient outcomes and asthma control, including a review of inhaler technique and record of exacerbations.
Asked by: Rachael Maskell (Labour (Co-op) - York Central)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health and Social Care, with reference to the NHS Long Term Plan, what progress has been made on the (a) delivery of and (b) timescales to tackle the over-reliance on short-acting beta agonist inhalers in asthma treatment.
Answered by Jo Churchill - Minister of State (Department for Work and Pensions)
Respiratory disease is a clinical priority of the NHS Long Term Plan. We are informed by NHS England and NHS Improvement that prior to the COVID-19 pandemic, an average of 2.25 million short-acting beta agonist (SABA) inhalers were prescribed per month in England. This over-use of aSABA inhalers can occur for multiple reasons and the work of the national respiratory programme is looking to address these issues as part of the NHS Long Term Plan, the Community Pharmacy Contractual Framework for 2019/20 to 2023/24 and the Quality Outcomes Framework (QOF).
These developments complement the work of other national quality improvement initiatives such as the asthma national audit programme.
The Community Pharmacy Contractual Framework for 2019/20 to 2023/24 includes: “The pharmacy can show evidence that asthma patients, for whom more than 6 short-acting bronchodilator inhalers were dispensed without any corticosteroid inhaler within a 6 month period, have since the last review point been referred to an appropriate health care professional for an asthma review”.
The QOF ensures all practices establish and maintain a register of patients with an asthma diagnosis in accordance with National Institute for Health and Care Excellence guidance. An update to the GP contract for 2020/21-2023/24 includes an improved QOF asthma domain. The content of the asthma review has been amended to incorporate aspects of care positively associated with better patient outcomes and self-management.
Asked by: Alex Norris (Labour (Co-op) - Nottingham North)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health and Social Care, whether the number of high dose steroids a severe asthma patient would be prescribed for including that category of condition in the shielded patient list during the covid-19 outbreak is in line with the recommendation made by the Royal College of Physicians in Why asthma still kills: the National Review of Asthma Deaths.
Answered by Jo Churchill - Minister of State (Department for Work and Pensions)
The decision to include people with severe respiratory conditions including all cystic fibrosis, severe asthma and severe chronic obstructive pulmonary disease on the shielded patient list was taken by expert doctors in England who identified specific medical conditions that, based on what we knew about the virus so far, would place someone at greatest risk of severe illness from COVID-19.
These were signed off by the UK Senior Clinicians Group (including the four United Kingdom Chief Medical Officers and clinical leadership at NHS England and NHS Improvement, NHS Digital and Public Health England).
Asked by: Liz Twist (Labour - Blaydon)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health and Social Care, what steps he has taken to monitor oral corticosteroid use by asthma patients who have not been able to access specialist respiratory services during the covid-19 outbreak.
Answered by Helen Whately - Minister of State (Department of Health and Social Care)
The National Institute for Health and Care Excellence COVID-19 rapid guideline on severe asthma provides guidance on the use of oral corticosteroids and starting or continuing on biological treatments, which aim to minimise oral corticosteroid exposure, for people with severe asthma during the COVID-19 outbreak. The guideline is available at the following link:
https://www.nice.org.uk/guidance/ng166