Wheeze Clinic: Reducing Avoidable Deaths from Asthma
This case study shows how bringing specialist care into GP practices can improve asthma management for kids and teens.
Background
In 2014, a National Bundle of Care was introduced to prevent asthma deaths. It followed a review that found many asthma patients didn’t seek help before their deaths. Over half hadn’t seen a specialist in the previous year.
The review also found that 21% of those who died had visited the emergency department in the last year. One in 10 died within 28 days of being discharged.
To help, the Bundle of Care recommends:
- Reviewing asthma triggers and medication use
- Checking inhaler technique
- Planning follow-up visits within 48 hours
- Creating Personalised Asthma Action Plans (PAAP)
- Advising on what to do if symptoms get worse
10 Years Later
A study in 2024 showed mixed results. Asthma deaths have risen by 25%, with 12,000 people dying since 2014.
Nearly 70% of asthma patients weren’t getting basic care like regular reviews or inhaler checks.
Poor follow-up was a significant issue—82% of patients didn’t get a GP appointment within 48 hours of an emergency visit.
Demands on Primary Care services are heavy, and booking short-notice appointments is often difficult.
The Project: A Designated Wheeze Clinic
Catherine Leonard, an Advanced Paediatric Nurse Practitioner, started the clinic.
She uses her experience from hospital care to treat kids with asthma in the local community. The clinic addresses gaps highlighted in the 2024 report.
How it works
- Catherine runs 45-minute appointments for kids aged 1-16, available one morning a week.
- She reviews each child’s asthma, develops a PAAP, and teaches proper inhaler use.
- These plans help parents, schools, and caregivers manage asthma symptoms and know what to do in an emergency.
We can improve their quality of life by working with patients to create a treatment plan that suits them.
Understanding Concerns
Understanding patients’ concerns and how much they know about asthma is key to managing the condition.
Catherine has heard concerns from parents and children that show misunderstandings and challenges in managing asthma.
“We’ve been told different things by different Doctors, who do we listen to?”
“What if it happens again? Who do we contact?”
“Can I still play sports and go out with my friends”
“Spacers aren’t cool – I’m not carrying that around with me”
‘”I’m worried school won’t believe me when I say I’m finding it hard to breathe – they take our inhalers and lock them away“
Results
The clinic has helped 48 patients, creating PAAPs for each. While it’s too early to see significant statistical changes, the stories of people like Alfie and Liam (not their real names) show its impact.
Alfie
Twelve-year-old Alfie came to the Same Day Access clinic with a dry cough that had lasted for months, worse at night and in the morning. He often felt short of breath while playing with friends.
He has mild hay fever and had been given a “blue inhaler years ago – but can’t really remember why.” Catherine started him on an ICS inhaler with Ventolin as needed, and scheduled a follow-up at the Wheeze Clinic in 6 weeks.
At the follow-up, Alfie had improved. His cough was gone, he slept better, and he could enjoy sports without breathlessness.
Alfie struggled with using a spacer, saying, “I’m already different, I don’t want to be more different.” Understanding this barrier, Catherine switched him to a combined preventer and reliever into one inhaler. This made him much happier.
His updated Personalised Asthma Action Plan (PAAP) was shared with his parents, school, and grandparents, giving guidance on what to do if his symptoms worsened.
Liam
Liam, 15, is an asthmatic with severe eczema who frequently visited the Same Day Access clinic. He had two hospital admissions in three months due to severe asthma attacks.
During one admission, Liam needed resuscitation, IV drugs, and several days of oxygen. It was found that he wasn’t using his ICS inhaler as prescribed and relied only on his reliever, which was empty.
Liam missed his first Wheeze Clinic appointment and often skipped other appointments.
Liam didn’t realize how dangerous asthma could be. Once he understood, he became more engaged. Catherine taught him how to use his inhalers correctly and the importance of maintenance therapy. They worked together on a plan that suited him.
At a follow-up appointment, Liam was more committed to managing his asthma. He said, “I didn’t realise asthma was so serious until you told me. Now, I make sure to take my inhalers and get new ones before they run out.”
What’s next for the Wheeze Clinic?
Catherine hopes to expand the clinic’s role in Jesmond and Gosforth, connect with hospital teams, and improve school asthma education.
The goal is to keep kids and young adults healthier and prevent more asthma-related deaths.
