Our Respiratory Mission

Our mission is to work towards ensuring that a number of recommendations are implemented for people with respiratory conditions in the UK. Critical to this is the need for improvements in: addressing inequalities through policy change; ending how we can achieve these ambitions.

Mission 1: Health inequalities in respiratory treatment and outcomes must be urgently investigated and addressed, including through guideline changes and policy solutions based on the latest and best evidence.

There are currently unacceptable levels of variation in asthma treatment and outcomes in England based on gender18, race19 and geography20. For instance, women have been found to be almost twice as likely to die from an asthma attack compared to men21. Similarly, there is significant geographic variation in the prevalence of COPD – prevalence of COPD in the 10% most deprived areas of England is estimated to be double that of the most affluent 10%22.

There is nearly a 50% difference in prescribing of oral corticosteroids (OCS) for patients with asthma or COPD in GP surgeries located in the most deprived areas, versus those located in the least deprived areas23. This is despite the fact there is now widespread recognition that maintenance use of OCS should be minimised in asthma and other respiratory patients due to the debilitating side effects associated with OCS usage24.

To address this variation, an investigation must be conducted into the causes of the variation and solutions implemented to proactively address it. As part of this review, clinical guidelines and respiratory policy interventions should be developed with consideration as to how structural inequalities can be addressed. These guidelines and interventions must then be consistently applied across the country. 

  • Reviewing guidelines and respiratory policy solutions and implementing recommendations which ensure factors associated with variation in respiratory treatment and outcomes are addressed proactively (including, where appropriate, co-creation with affected groups) 
  • Using advances in digital technology to improve access to specialist care and treatment, including through remote consultations and monitoring, to ensure all patients are able to access the care they need
  • A series of targeted and resourced interventions in the areas of highest need and which are designed to meet the needs of that population

Mission 2: End the dependence on OCS maintenance therapy.

There should be a commitment to end maintenance oral corticosteroids (OCS) use so that patients are offered treatments that are clinically appropriate for them at the right time, avoiding OCS as a default therapy while other treatment options remain available.

There is widespread recognition that long term maintenance OCS use for asthma and other respiratory patients should be minimised. Continuous use is associated with debilitating side effects for some patients25. Given recent advances in available therapies for asthma, it is unacceptable for asthma patients to remain on maintenance OCS while other treatment options, that in some cases will be more clinically appropriate, are available.

For COPD patients, ensuring they are on the right medicines at the right time is crucial for reducing their risk of exacerbations. This is particularly important because acute exacerbations of COPD are often treated with antibiotics26 – so avoiding this is key to ensuring we support efforts underway to combat antimicrobial resistance in the UK.

  • Identifying severe asthma and COPD patients early, and ensuring they are assessed in the appropriate setting and placed on the most suitable treatment for them, preventing a dependence on prescribing maintenance OCS and unnecessary exacerbations.
  • Expanding the pool of healthcare professionals able to review patients requiring specialist care and permitting prescribing of novel medicines, outside of specialist centres, to reduce bottlenecks which may be leading to continued OCS prescribing.
  • The NHS must commit to exploring all available therapies in instances of treatment failure and to end the prescribing of maintenance OCS as a default treatment.

Mission 3: Create a world-leading centralised data repository, joining up respiratory data across the health system and enabling patients to input their data directly.

At Sanofi, we support Asthma and Lung UK’s ambition to make the UK a lung research superpower, including their calls to “Make the UK the best place to do lung research and innovation by joining up our unique datasets and including respiratory biomarkers in largescale cohort studies”.27

There should be a commitment to seamlessly integrate patient records across the health system, including in primary, secondary, tertiary and social care settings. This will enable a world-leading respiratory data platform, supporting the NHS to identify patients who should be referred for assessment and providing the potential for anonymised data to be available for research on an unprecedented scale.

Opening the repository up for patients to input their own data would create a world-first database, putting the patient at the centre of their own care and contributing valuable real-world evidence to researchers.

The nature of a nationalised health service provides unique potential for the UK to be a world-leader in respiratory research, with the potential to attract investment and talent to the UK life sciences sector. We must maximise the potential competitive advantage that this represents to the UK.

  • Funding for an advanced data capacity platform to enable greater use of both NHS and real-world data in respiratory research and innovation, as called for by Asthma and Lung UK25
  • A coordinated, national approach to joining up respiratory data from across the health system, with all tiers of NHS provision required to input into a new platform.
  • This could include incorporating data from existing data hubs and registries.

In the Media

Read more about Sanofi’s work to tackle inequalities in respiratory care in this article we authored in the HSJ

References

18 ALUK. Women almost twice as likely to die from asthma than men, 2022. Available at: https://www.asthmaandlung.org.uk/women-almost-twice-as-likely-to-diefrom-asthma-than-men/

19 Busby J et al. UK Severe Asthma Registry. Ethnic Differences in Severe Asthma Clinical Care and Outcomes: An Analysis of United Kingdom Primary and Specialist Care. J Allergy Clin Immunol Pract. 2022 Feb;10(2):495-505.e2. doi: 10.1016/j.jaip.2021.09.034.

20 Gupta, R. P., Mukherjee, M., Sheikh, A., & Strachan, D. P. (2018). Persistent variations in national asthma mortality, hospital admissions and prevalence by socioeconomic status and region in England. Thorax, 73(8), 706–712. https://doi.org/10.1136/thoraxjnl-2017-210714

21 ALUK. Women almost twice as likely to die from asthma than men, 2022. Available at: https://www.asthmaandlung.org.uk/women-almost-twice-as-likely-to-diefrom-asthma-than-men/

22 House of Commons Library, Research Briefing: Support for people with chronic obstructive pulmonary disease. 2021. Available at https://commonslibrary.parliament.uk/research-briefings/cdp-2021-0188/.

23 York Health Economics Consortium (2022) – Data held on file

24 Menzies-Gow A, Canonica G, Winders TA. et al. A Charter to Improve Patient Care in Severe Asthma. Adv Ther. 2018;35:1485-9.

25 Sullivan PW, et al. Oral corticosteroid exposure and adverse effects in asthmatic patients. Journal of Allergy and Clinical Immunology. 2017;141(1):110–6.e7.

26 NICE (2018). Chronic obstructive pulmonary disease (acute exacerbation): antimicrobial prescribing. Available at: https://www.nice.org.uk/guidance/ng114/chapter/Recommendations

27 ALUK. Investing in Lung research: Making the UK a lung research superpower, 2023. Available at: https://www.asthmaandlung.org.uk/wp-content/uploads/2023/02/Research_Superpower_report.pdf

MAT-XU-2304563 (v1.0)

June 2024