Brent's Community and Wellbeing Scrutiny Committee has demanded better data collection and analysis to address the borough's high rates of childhood asthma.
During a meeting on Wednesday, 16 September 2026, councillors heard that Brent has significantly higher childhood asthma admission rates compared to the London average. For children aged 0-9 years, Brent has the second highest emergency admissions rate of all London boroughs, and for children aged 10-18 years, it also ranks second. The gap between Brent and the London average has widened over the past five years. While asthma admissions tend to be higher in the most deprived parts of Brent, there isn't a clear socioeconomic gradient across all areas, with admission rates being highest in Harlesden and lowest in Kilburn.
Dr. Ruth Duplicy, Director of Public Health, presented data indicating that while progress has been made through a multi-agency approach, including increased asthma diagnoses and a reduction in severe exacerbations, more targeted work is needed. Several initiatives have been implemented:
- Childhood Asthma Local Enhanced Service (LES): This initiative combined proactive case finding with enhanced reviews for high-risk children aged 5-17. Measurable outcomes included a 56.5% increase in new asthma diagnoses, a reduction in oral prednisolone prescribing by 81% (indicating fewer severe exacerbations), and a 59% reduction in high-risk SABA (short-acting beta-agonist) inhaler prescribing, suggesting improved asthma control. While hospital admissions fell by 12.4%, this reduction was not significantly greater than seen across North West London.
- Brent Health Matters Children and Young People (BHM CYP) Asthma Programme: This programme aims to reduce inequalities and improve asthma management through community outreach, training for asthma community coaches, and the development of multilingual resources. Measurable outcomes include the training of 88 community coaches (with 33 more planned), improved confidence and knowledge among trained coaches, and the distribution of 32 spacer packs. The programme has also developed multilingual resources and videos, and a FeNO machine was purchased in August 2026 to support community-based asthma assessments.
- Asthma Friendly Schools Programme: This initiative involves schools working with school nurses to achieve accreditation. As of the meeting, 23 primary schools (42.6%) and 2 secondary schools (12.5%) had achieved Asthma Friendly School status, with an additional 27 primary schools (50%) and 8 secondary schools (50%) working towards it.
- Asthma Nurse Specialist (ANS) Service: Following a review, the service has seen a 66% increase in referrals after pathway redesign, including the removal of restrictive referral criteria and the acceptance of parent self-referrals. The service is a single 0.9 WTE post, but is part of a wider system-wide team of asthma specialists.
Committee members raised questions about the consistency and rationale for variations in admission rates across different neighbourhoods and specific measures to address higher rates among certain ethnic groups. The prevalence of diagnosed childhood asthma is highest in children from Black ethnic groups (6.5%). Within Brent, asthma admission rates are above average for children from Pakistani and Mixed White & Black Caribbean ethnic groups. For disaggregated ethnic groups, children from a Black Caribbean background have a prevalence of 8.7%, Black African background 5.7% and Pakistani background 7.2%. The BHM CYP Asthma Programme is actively working to reduce these inequalities through community outreach, training for asthma community coaches, and the development of multilingual resources. The programme also aims to address wider determinants of health such as damp and mould in housing. The Asthma Community Coaches Programme trains trusted community members from diverse demographics to provide culturally appropriate asthma education and support. The programme has developed resources in six languages and five awareness videos in seven languages.
Concerns were also raised about the presentation of data, with inconsistencies noted in figures related to emergency department admissions and hospital admissions for asthma. Councillors stressed the need for clear, accurate, and consistent data to effectively scrutinise the issue and inform targeted interventions. The meeting discussed improvements in data collection and analysis. For the Childhood Asthma Local Enhanced Service (LES), the focus for 2026/27 includes maximizing completion of high-risk reviews, increasing coverage of personalized asthma action plans, reviewing prescribing patterns (particularly SABA overuse), strengthening links with housing, smoking cessation, and social prescribing services, and monitoring outcomes related to exacerbations, oral steroid use, and unplanned care utilization. The Asthma Nurse Specialist Service is implementing an improvement programme including enhanced professional development, development of promotional materials, increased use of digital appointment reminders, a formal Standard Operating Procedure (SOP) with clear escalation pathways, continued use of Cerner A&E attendance notifications as a primary referral source, removal of restrictive referral criteria, and rescheduling clinic sessions to later in the day.
Risk factors such as air pollution, damp and mould in housing, overcrowding, and lower vaccination rates were highlighted as significant contributors. Brent rates of damp housing are similar to or lower than the London average, although annual figures indicate some data quality issues. In 2023 and 2024, approximately 7-8% of social rented homes in Brent had damp. Damp is more commonly recorded in social rented homes compared with other housing tenures. The report notes that this presents an opportunity to tackle asthma through housing improvements and initiatives targeted at social housing tenants. The BHM CYP Asthma Programme has developed a resource on damp and mould, and community coaches are trained to look for and help families address these environmental risk factors.
Vaccination rates in Brent are generally lower than the London average, which is a concern for respiratory health. Specifically, Brent has the lowest flu vaccination coverage in London for primary school children (29.1% in 2024, compared to a London mean of 44.1%), and this has not improved in recent years. Flu vaccination coverage for younger children is also lower than London. Brent's MMR coverage (74.1% for one dose by 24 months) is below the London average (79.2%). While PVC vaccine coverage is close to the London average, the report highlights that lower respiratory tract infection rates are higher in Brent compared with London, and the rate in children aged 2-4 years has almost doubled between 2021/22 and 2024/25. The report states that lower respiratory tract infections are linked to the development of asthma symptoms and exacerbation of the illness, and that lower vaccination uptake highlights a risk for children and young people in Brent relating to respiratory health.
Beyond air pollution, damp and mould, overcrowding, and vaccination rates, other potential risk factors for childhood asthma being investigated or considered in Brent include multiple deprivation, household and maternal smoking, lower respiratory tract infections, and premature births and low birth weight. Socioeconomic disadvantage is linked to higher asthma prevalence, with disadvantaged families facing greater exposure to poor quality housing, higher levels of air pollution, and second or third-hand smoke. Chronic stress, financial insecurity, and unstable housing can also influence immune and inflammatory pathways associated with asthma. Children living in households where smoking occurs are more likely to experience wheezing and asthma symptoms. Maternal smoking at the time of delivery has decreased but remains a factor. Brent has a higher rate of premature births and a higher percentage of low-birth-weight babies compared to the London average, which are also considered potential contributors to respiratory health issues.
For further details, please refer to the Childhood Asthma Report Data Pack 2026 and the Public reports pack Wednesday 16-Sep-2026 18.00 Community and Wellbeing Scrutiny Committee.
