I recognised there was a gap in understanding asthma

Dr Noel Baxter of the Primary Care Respiratory Society, a member of the Taskforce for Lung Health, describes the progress that has been made in diagnosing and treating people with asthma, and the steps that patients and healthcare practitioners can take now to ensure asthma is managed correctly.

Dr Noel

Asthma was a part of my life growing up. My brother had asthma as a young child. I remember blue inhalers. I remember him being frightened. I remember this sense of how he couldn’t control it. And of course, my brother, born in 1968, the same year as me, would have never received inhaled corticosteroids as it wasn’t part of the treatment programme at that stage. A lot has changed since then.

In my 27 years as a doctor, I’ve seen how much progress we’ve made

During my career as a GP, helping patients manage their asthma has mainly been the responsibility of the practice nurse. As a GP trainee, you did one or two sessions with the nurse watching her do an asthma review, and then that was it as far as prevention is concerned. When I was training as a GP, there wasn’t much focus on managing long term conditions and whilst diabetes was coming to the fore, respiratory health was still behind. When the new GP contract came in and with that, the Quality Outcomes Framework (QOF) in 2004, asthma became even more of a nurse managed condition. Doctors generally managed the acute presentation for an asthma or COPD attack. That was pretty much our bag as GPs. Our primary care nurse colleagues then became more and more skilled in respiratory and the gap between what the primary care nurses and doctors knew, especially regarding new developments in respiratory, began to widen. It was the beginning of an explosion in competing guidelines and national frameworks and under that pressure respiratory fell down the list somewhat.

I recognised that there was a gap

It was only by chance that I got into respiratory in some ways. I recognised that there was a gap, because our nurse was developing more in her diabetes skills in the practice I was a partner at. It’s interesting to think that if there had been a nurse who was taking a lead in asthma or COPD care I might not have made this my mission. But because I saw that there was a gap, a need to improve the service, I then started - despite feeling a bit daunted - to try and educate myself.

I think I have some quality improvement gene inside of me. Which ultimately, has been perceived by some as quite annoying. A bit like when an artist says they have to draw, or a writer has to write, they get up and that’s what they have got to do today, it’s that irritating itch of sorts, where I feel a need to improve things.

Seeing the gaps in asthma and COPD care and the lack of leadership and training available to other GPs motivated me to try and learn more and make a difference.

Checking and correcting inhaler technique is vital

Years later, one thing that has come up time and time again in the field of asthma and COPD care is inhaler technique. A lot of health care practitioners do not feel well trained enough to support people with respiratory disease and the huge growth in respiratory drugs and devices leave many feeling underconfident in their ability to check inhaler technique.

A moment of awkwardness in not wanting to ask a patient if you could check their technique could have life changing consequences for their health. We need to help HCPs and patients to avoid any doubts about checking inhaler technique. The UK Inhaler Group, who work with the Taskforce for Lung Health, have helpfully put together seven steps for practitioners to follow when teaching patients correct inhaler technique.

You can find these on the UK Inhaler Group website.


Taskforce member, Asthma UK, also have some helpful videos for improving inhaler technique on their website.


The Taskforce for Lung Health is committed to improving inhaled therapy and recommends a clear pathway for accurate prescribing and adherence. If you have a story to share about your experiences of using an inhaler for your lung condition, you can get in touch with us at yourstory@blf.org.uk.

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5 May 2020