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The SENTINEL Project

In this blog by Dr Michael Crooks, senior clinical lecturer and honorary consultant in respiratory medicine at Hull York Medical School and Hull University Teaching Hospitals NHS Trust, he discusses how the SENTINEL project addressed the environmental impact of asthma and its treatment.

The SENTINEL Project is a co-designed, collaborative quality improvement programme that started in Hull and East Yorkshire in November 2020 and aimed to: i) improve patient outcomes and ii) reduce the environmental impact of asthma and its treatment. This was achieved by identifying and addressing short-acting beta agonist (SABA) over-reliance through supported implementation of a local, SABA-free, maintenance and reliever therapy (MART)-based asthma guideline.

There are around 5.4 million people being treated for asthma in the UK. Despite advances in our understanding of asthma and its treatment, it remains a common cause of morbidity and mortality. SABA over-use (three or more SABA inhalers per year) is associated with increased risk of asthma attacks and death. Despite this, >21 million SABA inhalers are prescribed each year in England, 94% of which are greenhouse gas containing pressurised metered dose inhalers (pMDI). Poorly controlled asthma has a significantly higher environmental impact than controlled asthma, with SABA the major contributor. As such, identifying and addressing SABA over-use, and introducing SABA-free approaches where appropriate, can improve both patient and environmental outcomes.

The SENTINEL Project supports delivery of guideline recommended asthma care using a co-designed intervention with the following five pillars: i) healthcare professional education, ii) implementation of ‘gold standard’ prescribing practice, iii) targeted asthma reviews, iv) patient support and education and v) real-time data monitoring and reporting of asthma care metrics. It has been rolled out sequentially across six primary care networks with ~21,000 registered asthma patients in Hull and East Yorkshire. Since the SENTINEL Project started, 44,275 fewer SABA inhalers have been prescribed within participating primary care networks (PCNs) than if prescribing patterns had remained unchanged from pre-SENTINEL levels. This is equivalent to a saving of around 1,240 metric tonnes of CO2 equivalent. Pilot PCN data revealed that fewer patients had an asthma attack in the year following SENTINEL implementation, confirming patient benefit.

Following the early positive results observed in the SENTINEL Project, the same co-designed intervention has been developed into a scalable quality improvement package, SENTINEL Plus, which has now been adopted by 250 PCNs across the UK. Data from early SENTINEL Plus adopter sites in England have demonstrated reduced SABA and increased inhaled corticosteroid prescribing following implementation, consistent with improved asthma care. More information about SENTINEL Plus and the SENTINEL Project can be found at https://sentinelplus.info.

The SENTINEL Project was a collaboration between Hull University Teaching Hospitals and AstraZeneca UK working on behalf of NHS Hull Clinical Commissioning Group.

SENTINEL Plus is a quality improvement package based on the SENTINEL Project. SENTINEL Plus is funded by AstraZeneca UK and co-developed with the University of Hull and Hull University Teaching Hospitals NHS Trust and supported by the Academic Health Sciences Network.