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.

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.