Improving asthma management in primary care

Supervisors: Dr Kay Wang; Dr Marta Wanat; Associate Professor Sarah Tonkin-Crine

Asthma is one of the most common chronic diseases in children and adults, with an estimated 5.4 million people receiving treatment for asthma in the UK. Severe asthma exacerbations requiring hospitalisation or emergency treatment are also associated with more rapid decline in lung function. Diagnosis and monitoring of asthma is mainly managed in primary care, with an estimated six million consultations related to asthma each year.

Our group is involved in important nationally funded research to improve the management of asthma in primary care. We have been awarded a £2.6 million NIHR Programme Grant to develop and evaluate the effectiveness of an online FeNO-guided asthma management intervention designed for use during routine primary care asthma reviews (www.define-study.com). FeNO (Fractional Exhaled Nitric Oxide) is a non-invasive breath test which provides an objective measure of steroid-responsive airway inflammation.  NICE already recommends that FeNO should be used to facilitate diagnosis of asthma, but has called for more evidence to inform its use in monitoring asthma patients. 

Our online intervention consists of a training module for health care professionals, an interactive FeNO-guided algorithm for generating personalised management recommendations for patients, and a patient information booklet.  We are currently conducting a large randomised controlled trial to determine whether our intervention is more effective than usual care at reducing acute exacerbations of asthma.  A mixed methods process evaluation to explore patients’ and clinicians’ views and experiences of implementing our intervention will be nested within the trial.

The student will have the opportunity to review the research plan for our NIHR Programme Grant and to develop novel research questions and relevant methodological expertise to design and deliver additional studies related to the theme of improving asthma management in primary care. 

Potential opportunities include:

• Conducting an overview of systematic reviews of interventions to improve medication adherence in patients with asthma. 

• Designing and conducting secondary analyses of quantitative and qualitative data from the process evaluation nested within the trial.   

• Analysing recordings of asthma review consultations to understand how FeNO is discussed between clinicians and patients and how FeNO results contribute to management decisions.

• Conducting a longitudinal qualitative interview study to explore patients’ perspectives on how they self-manage their condition and utilise health care resources over time.

Who should apply

This project would be an ideal opportunity for a student looking to gain experience in trial methodology, mixed methods and qualitative research.  Important subject themes within this programme include asthma management, personalised medicine and health care service delivery.

Research group

This DPhil will be embedded in the Infectious diseases and Acute Care Research Group