Guy's Severe Asthma Centre
The asthma service at Guy’s & St Thomas’ NHS Foundation Trust in London is a globally recognised centre of excellence specialising in the care of patients with asthma and other eosinophilic lung diseases.
The out-patient service, based at Guy’s Hospital, is the busiest asthma service in the UK, reviewing over 250 patients per week with difficult-to-control and severe asthma across its multidisciplinary team made up physicians, specialist nurses, pharmacists, respiratory physiotherapists, clinical psychologist and speech and language therapist.
Guy’s Severe Asthma Centre has a strong track record in education and training and is actively involved in clinical and translational research. Currently the Centre is leading several International and UK-based multi-centre studies in asthma and publishes a large number of original research studies each year.
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Our team
Professor David Jackson, Director of ISAN
MRCP MSc PhD
Consultant in Asthma & Eosinophilic Lung Diseases
Clinical Lead, Guy’s Severe Asthma Centre
Consultant in Asthma & Eosinophilic Lung Diseases
Clinical Lead, Guy’s Severe Asthma Centre
David Jackson is a Professor in Respiratory Medicine at King’s College London and Clinical Lead for the Severe Asthma and Eosinophilic Lung Disease Service at Guy's and St Thomas' Hospitals in London.
Dr Jackson has an MSc in Allergy and a PhD in the pathophysiology of asthma exacerbations from Imperial College London. He has published widely in the field of type 2 immunity, biologic therapies in asthma, and the mechanisms of virus-induced asthma exacerbations.
He is a current member of the British Thoracic Society Asthma advisory group, is a GINA assembly member, and is on the steering committee of the International Severe Asthma Registry.
He is an Associate Editor at the journals THORAX and ALLERGY, the Reviews Editor at CHEST, and was the editor of the ERS Monograph book on Eosinophilic Lung Diseases.
Dr Alexandra Nanzer
MRCP PhD
Consultant in Asthma & Eosinophilic Lung Diseases
Consultant in Asthma & Eosinophilic Lung Diseases
Dr Alexandra Nanzer is a Consultant Respiratory Physician at Guy’s Severe Asthma Centre, Guy’s and St Thomas’ NHS Foundation Trust. She obtained a PhD at the MRC & Asthma UK Centre at King’s College London, supported by Asthma UK.
She has a specialist interest in the adverse metabolic, skeletal and psychological effects of steroid therapy in severe asthma and oversees the biomarker-led oral steroid weaning clinic.
Dr Nanzer additionally leads the Asthma Transition Service for the South-East England network holding monthly clinics together with her paediatric colleagues in the surrounding paediatric asthma centres as well as supporting General Practitioners caring for adolescents with asthma.
Dr Jaideep Dhariwal
MRCP PhD
Consultant in Asthma & Eosinophilic Lung Diseases
Consultant in Asthma & Eosinophilic Lung Diseases
Dr Jaideep Dhariwal was appointed as a Consultant Respiratory Physician at Guy’s Severe Asthma Centre, Guy’s and St. Thomas’ Foundation Trust, in 2019, having previously been a Clinical Lecturer at Imperial College London.
He has a regular clinic for review of secondary care patients following discharge post-acute asthma exacerbation as well as a weekly specialist clinic for patients with eosinophilic lung disease.
He is part of the specialist multi-disciplinary team who care for patients with severe eosinophilic asthma and EGPA. In addition he is part of the acute general medical rota and has a regular bronchoscopy list for both NHS and clinical research patients.
He has a regular clinic for review of secondary care patients following discharge post-acute asthma exacerbation as well as a weekly specialist clinic for patients with eosinophilic lung disease.
He is part of the specialist multi-disciplinary team who care for patients with severe eosinophilic asthma and EGPA. In addition he is part of the acute general medical rota and has a regular bronchoscopy list for both NHS and clinical research patients.
He obtained a PhD investigating mechanisms of allergen and respiratory viral induced exacerbations of asthma in 2016, from Imperial College London with a specific focus on the role of innate lymphoid cells in asthma.
Grainne d’Ancona
Consultant Respiratory Pharmacist
Gráinne is the consultant pharmacist for respiratory medicine at Guys and St Thomas’ NHS Foundation Trust and a senior lecturer at King's College London.
She has contributed to national guidelines and training programmes, is a clinical champion for the asthma biologics rapid uptake programme of the NHSE Accelerated Access Collaborative and holds several national committee seats, most notably on the NHSE & NHSI inhaler sustainability delivery board, the RCP national Asthma and COPD audit programme, the BTS pharmacist special advisory group and chairs the NHS London region respiratory medicines optimisation group.
An advocate for integrated respiratory care and value based interventions, her clinical roles include optimising care for patients with severe asthma, COPD, ILD and sleep disorders, in the hospital setting and also through virtual clinics in general practice. Her particular area of academic interest is medicines adherence.
She has contributed to national guidelines and training programmes, is a clinical champion for the asthma biologics rapid uptake programme of the NHSE Accelerated Access Collaborative and holds several national committee seats, most notably on the NHSE & NHSI inhaler sustainability delivery board, the RCP national Asthma and COPD audit programme, the BTS pharmacist special advisory group and chairs the NHS London region respiratory medicines optimisation group.
An advocate for integrated respiratory care and value based interventions, her clinical roles include optimising care for patients with severe asthma, COPD, ILD and sleep disorders, in the hospital setting and also through virtual clinics in general practice. Her particular area of academic interest is medicines adherence.
Louise Thomson
Asthma Nurse Specialist
Louise Thomson is a Deputy Clinical Nurse Specialist in the Guy’s Severe Asthma Centre, where she carries out a mixture of inpatient and outpatient work.
Her inpatient work involves ward rounds and support for ward staff and her outpatient work comprises of a variety of clinics. These include the adolescent transition, biologics and prednisolone weaning clinics, as well as nurse-led reviews.
Louise is passionate about education and continuous professional development and is currently studying for a master’s degree in Advanced Clinical Practice in order to become a nurse prescriber.
Her inpatient work involves ward rounds and support for ward staff and her outpatient work comprises of a variety of clinics. These include the adolescent transition, biologics and prednisolone weaning clinics, as well as nurse-led reviews.
Louise is passionate about education and continuous professional development and is currently studying for a master’s degree in Advanced Clinical Practice in order to become a nurse prescriber.
Mariana Fernandes
Asthma Nurse Specialist
Mariana Fernandes, Registered Nurse, has been working as an Asthma Clinical Nurse Specialist at Guy’s Severe Asthma Centre for the past 3 years.
She has previously worked with the COPD and Oxygen team. Prior to that, she was part of the Intensive Care team both at Guy’s and St Thomas’ Trust and also outside London.
She started her nursing career in a general respiratory ward back in 2012. She is currently on year 2 of the Masters in Advanced Clinical Practice at King’s College London and undertaking the Independent Prescribing Module for Nurses.
She has previously worked with the COPD and Oxygen team. Prior to that, she was part of the Intensive Care team both at Guy’s and St Thomas’ Trust and also outside London.
She started her nursing career in a general respiratory ward back in 2012. She is currently on year 2 of the Masters in Advanced Clinical Practice at King’s College London and undertaking the Independent Prescribing Module for Nurses.
Cris Roxas
Advanced Nurse Practitioner in Asthma
Cris Roxas trained at Guy’s and St. Thomas’ hospital and qualified at King’s College London, in 2009.
She has been awarded the Associateship of King’s College award. She has a Masters in Advanced Nursing Practice at King’s and is a non-medical prescriber.
She currently works as an asthma advanced nurse practitioner at Guy’s and St. Thomas’ hospital as well as the Governance lead for respiratory. She is the lead asthma nurse of one of UK’s nationally commissioned severe asthma centres.She runs a regional secondary care asthma nurses network.
One of her many passions is to upskill the nursing body to enhance patient asthma control.
She has been awarded the Associateship of King’s College award. She has a Masters in Advanced Nursing Practice at King’s and is a non-medical prescriber.
She currently works as an asthma advanced nurse practitioner at Guy’s and St. Thomas’ hospital as well as the Governance lead for respiratory. She is the lead asthma nurse of one of UK’s nationally commissioned severe asthma centres.She runs a regional secondary care asthma nurses network.
One of her many passions is to upskill the nursing body to enhance patient asthma control.
Linda Green
Asthma Nurse Specialist
Linda Green is a Clinical Nurse Specialist within the Severe Asthma Service at Guy’s and St Thomas’ NHS Trust and leads its asthma biologic service. Linda has an MSc in Pharmaceutical Medicine from Surrey University and is registered as both an adult and paediatric nurse. Linda did her initial training in Australia as both a nurse and midwife.
Linda has worked for many years within asthma and respiratory clinical research in the UK and has experience in all aspects of the trial process from initiation to completion of studies, she joined the Trust in 2016 to focus on its asthma biologic provision.
Emma Turner
Speech & Language Therapist
Emma Turner is a Respiratory Speech & Language Therapist (SLT), working since 2019 in the Severe Asthma Service at Guy’s Hospital as the laryngeal (throat) specialist within the team. As well as dedicating her time to develop the SLT role within Asthma, Emma also works as a Voice Specialist within the ENT service.
She is a dedicated member of the Asthma team, who enjoys her work helping patients presenting with symptoms of breathlessness, accompanied by a sensation of choking, throat tightness, voice changes and /or altered sensations in and around the throat area, also known as Upper Airway Disorders.
Emma is currently on the organising committee of the National SLT Upper Airways Clinical Excellence Network, a voluntary network of SLT’s supporting colleagues expanding into this field of work.
She is a dedicated member of the Asthma team, who enjoys her work helping patients presenting with symptoms of breathlessness, accompanied by a sensation of choking, throat tightness, voice changes and /or altered sensations in and around the throat area, also known as Upper Airway Disorders.
Emma is currently on the organising committee of the National SLT Upper Airways Clinical Excellence Network, a voluntary network of SLT’s supporting colleagues expanding into this field of work.
Dr Kirsten Stewart-Knight
Clinical Psychologist
Dr Kirsten Stewart-Knight is our team’s Asthma Clinical Psychologist who has been part of the team since 2018.
Kirsten works with patients and their families to reduce the impact of their breathing difficulties on quality of life and relationships and to increase the effectiveness of other treatments.
Asthma psychology aims to help you to improve your health and communication in order to help you get the most out of your appointments with the multidisciplinary asthma team. An asthma psychology consultation will also aim to help you understand how your breathing condition and psychological pressures (including past or current stress, health experiences, trauma, relationship difficulties, discrimination, mental health difficulties) may be affecting one another.
Kirsten works with patients and their families to reduce the impact of their breathing difficulties on quality of life and relationships and to increase the effectiveness of other treatments.
Asthma psychology aims to help you to improve your health and communication in order to help you get the most out of your appointments with the multidisciplinary asthma team. An asthma psychology consultation will also aim to help you understand how your breathing condition and psychological pressures (including past or current stress, health experiences, trauma, relationship difficulties, discrimination, mental health difficulties) may be affecting one another.
Dr Leyla Osman
Consultant Respiratory Physiotherapist
Dr Leyla Osman is a Senior Consultant Respiratory Physiotherapist, responsible for the Respiratory Phsyiotherapy services at Guy’s and St. Thomas’ Hospitals.
Leyla completed a PhD in Pharmacology and Toxicology at Imperial College London before moving in to healthcare and qualifying from King’s College London as a Physiotherapist.
Leyla completed a PhD in Pharmacology and Toxicology at Imperial College London before moving in to healthcare and qualifying from King’s College London as a Physiotherapist.
Since qualifying Leyla has held a Research Fellowship with the National Heart and Lung Institute at Imperial College investigating airway clearance in Cystic fibrosis, before joining Guy’s and St. Thomas’ NHS Foundation Trust in 2007. She has a specialist interest in disordered breathing, airway clearance, ILO and cough in those with and without lung disease, pulmonary rehabilitation, oxygen prescription and Post-COVID syndrome.
She is a Senior Lecturer (Teaching) at UCL, where she is a faculty member of the Advanced Cardiorespiratory Physiotherapy Post-Graduate programme, leading a module on Health Management and Exercise in Pulmonary Disease.
Jodie Lam
Deputy Clinical Nurse Specialist in Asthma Care
Jodie is new to the Severe Asthma Team and works as a Deputy Clinical Nurse Specialist, after spending 18 months in Respiratory Research.
Prior to this Jodie was a Senior Staff Nurse on an Acute Admissions Ward at St Thomas' Hospital, where she began her Nursing career, after training at King's College London University. Jodie also has a Biomedical Science BSc which is where her interest in Research and Medicine started. In the Severe Asthma Team, Jodie carries out Nurse-led clinics, prednisolone weaning clinics, and rapid access reviews for unwell patients.
She has completed her Advanced Assessment Course and will eventually like to enrol on the Master's Programme, Advanced Clinical Practice.
Prior to this Jodie was a Senior Staff Nurse on an Acute Admissions Ward at St Thomas' Hospital, where she began her Nursing career, after training at King's College London University. Jodie also has a Biomedical Science BSc which is where her interest in Research and Medicine started. In the Severe Asthma Team, Jodie carries out Nurse-led clinics, prednisolone weaning clinics, and rapid access reviews for unwell patients.
She has completed her Advanced Assessment Course and will eventually like to enrol on the Master's Programme, Advanced Clinical Practice.
Our clinics
Severe asthma
This is the main clinic of the service and manages patients with poorly-controlled and treatment-resistant asthma. It primarily focuses on differentiating severe asthma from ‘difficult-to-control’ asthma and the prompt identification of patients who will benefit from targeted biologic therapies.
Asthma Consultants: Dr Jackson, Dr Nanzer, Dr Dhariwal
Related publications:
Covid-19 in the absence of eosinophils: The outcome of confirmed SARS-COV-2 infection whilst on treatment with benralizumab
Benralizumab Effectiveness in Severe Asthma Is Independent of Previous Biologic Use
The prevalence of mucus plugging in severe eosinophilic asthma and its relationship to clinical efficacy of anti-IL-5R treatment
Asthma Consultants: Dr Jackson, Dr Nanzer, Dr Dhariwal
Related publications:
Covid-19 in the absence of eosinophils: The outcome of confirmed SARS-COV-2 infection whilst on treatment with benralizumab
Benralizumab Effectiveness in Severe Asthma Is Independent of Previous Biologic Use
The prevalence of mucus plugging in severe eosinophilic asthma and its relationship to clinical efficacy of anti-IL-5R treatment
Real-World Effectiveness of Anti-IL-5/5R Therapy in Severe Atopic Eosinophilic Asthma with Fungal Sensitization
The relationship between Feno and effectiveness of mepolizumab and benralizumab in severe eosinophilic asthma
Benralizumab after sub-optimal response to mepolizumab in severe eosinophilic asthma
Real-World Effectiveness of Benralizumab in Severe Eosinophilic Asthma
Real-World Effectiveness and the Characteristics of a "Super-Responder" to Mepolizumab in Severe Eosinophilic Asthma
The relationship between Feno and effectiveness of mepolizumab and benralizumab in severe eosinophilic asthma
Benralizumab after sub-optimal response to mepolizumab in severe eosinophilic asthma
Real-World Effectiveness of Benralizumab in Severe Eosinophilic Asthma
Real-World Effectiveness and the Characteristics of a "Super-Responder" to Mepolizumab in Severe Eosinophilic Asthma
Rapid Access Review and OCS stewardship
These T2 biomarker-led clinics have two key functions:
Specialist Nurses: Cris Roxas, Louise Thomson, Mariana Fernandes, Jodie Lam
- Steroid weaning (based on biomarkers, not symptoms) for symptomatic patients referred on maintenance oral corticosteroids who appear poorly-controlled despite fully suppressed T2 inflammation.
- Rapid review of deteriorating patients with an apparent ‘T2-low’ phenotype to limit inappropriate prescription of systemic steroids.
Specialist Nurses: Cris Roxas, Louise Thomson, Mariana Fernandes, Jodie Lam
T2 biologics
For patients initiating biologic therapies. This clinic is run by specialist nurses who have initiated over 500 patients on biologic therapies for asthma. The main focus is to assess and record the response to therapy and train the patients to self-administer in the home setting.
Specialist Nurses: Linda Green, Louise Thomson
Specialist Nurses: Linda Green, Louise Thomson
Treatment adherence and medicines optimisation
This clinic is specifically for the assessment and ongoing support of patients with suboptimal adherence to therapy. It utilises a range of assessment tools including remote e-monitoring of inhaler use and FeNO suppression testing.
Consultant Respiratory Pharmacist: Grainne d’Ancona
Adolescent and young adult asthma transition
This is a multi-disciplinary clinic supporting adolescents and young adults as they transition from paediatric care to Guy’s Severe Asthma Centre. Adolescents receive support from a dedicated transition coordinator, as well as for medicines adherence, clinical psychology, physiotherapy and speech and language therapy (SALT) as needed.
Transition Service Lead: Dr Alexandra Nanzer
Related publication:
Transitioning Asthma Care From Adolescents to Adults: Severe Asthma Series
Transition Service Lead: Dr Alexandra Nanzer
Related publication:
Transitioning Asthma Care From Adolescents to Adults: Severe Asthma Series
Asthma ‘Hot’ clinic
This weekly clinic functions to enable early follow-up of patients who have either been admitted to hospital or presented to the emergency room with an acute exacerbation within the previous 4 weeks.
It focuses on patient education, and identifying and correcting the cause (e.g. for poor ICS adherence) and understanding the trigger (e.g. respiratory virus) for the exacerbation.
Asthma Consultant: Dr Jaideep Dhariwal
It focuses on patient education, and identifying and correcting the cause (e.g. for poor ICS adherence) and understanding the trigger (e.g. respiratory virus) for the exacerbation.
Asthma Consultant: Dr Jaideep Dhariwal
Clinical psychology
Dr Stewart-Knight works with asthma patients and their families to reduce the impact of their breathing difficulties on quality of life, relationships and to increase the effectiveness of other treatments. An asthma psychology consultation aims to help patients understand how respiratory symptoms and psychological pressures (including past or current stress, health experiences, trauma, relationship difficulties, discrimination, mental health difficulties) may be affecting one another.
Clinical Psychologist: Dr Kirsten Stewart-Knight
Clinical Psychologist: Dr Kirsten Stewart-Knight
Asthma physiotherapy
Disorders of breathing pattern are a common cause of respiratory distress in the asthma clinic and are frequently characterised by a disproportionate symptom burden relative to objective airflow obstruction or airways inflammation. Our respiratory physiotherapy team led by Dr Leyla Osman focuses on identifying and treating this co-morbidity in our patients using breathing retraining techniques focusing on normalising the ventilatory pattern at rest and with activity.
Service Lead: Dr Leyla Osman
Service Lead: Dr Leyla Osman
Laryngeal dysfunction
Upper Airway Disorders not only exist alone, but are increasingly recognised in patients with asthma, exacerbating and mimicking asthma symptoms. Such conditions affect laryngeal muscle co-ordination, causing the vocal cords to shut inappropriately, with symptoms ranging from breathlessness, wheeze and cough, to voice disturbances. Speech & Language Therapy treatment is the mainstay intervention to help reset the pattern and behaviour of the larynx.
Service Lead: Emma Turner
Service Lead: Emma Turner
EGPA and eosinophilic lung disease
The specialist clinic for patients with EGPA and eosinophilic pneumonia runs monthly and is the largest of its kind in the UK. A dedicated MDT of physicians jointly review patients including asthma physicians, rheumatologists, a cardiologist with a special interest in cardiac vasculitis and ENT surgeon with a special interest in sinonasal disease in asthma and EGPA.
MDT care involving: Dr Jackson, Dr Nanzer (Respiratory); Dr Agarwal, Prof D’Cruz, Dr Fernando (Rheumatology); Dr Ismail (Cardiology); Prof Hopkins (ENT)
Supporting services
The asthma service is additionally supported by:
Guy's and St Thomas' Allergy Service
(WAO Centre of Excellence in Allergy)
Dr Leonard Siew, Consultant Allergist and Service Lead
Related publications:
Cigarette smoking increases bronchial mucosal IL-17A expression in asthmatics, which acts in concert with environmental aeroallergens to engender neutrophilic inflammation
- Identifying Low-Risk Beta-Lactam Allergy Patients in a UK Tertiary Centre
- Synchronous Telemedicine in Allergy: Lessons Learned and Transformation of Care During the COVID-19 Pandemic
Cigarette smoking increases bronchial mucosal IL-17A expression in asthmatics, which acts in concert with environmental aeroallergens to engender neutrophilic inflammation
Guy's and St Thomas' Rhinology Service
Prof Claire Hopkins, Consultant ENT Surgeon and Professor of Rhinology
Related publications:
Efficacy and safety of dupilumab in patients with severe chronic rhinosinusitis with nasal polyps (LIBERTY NP SINUS-24 and LIBERTY NP SINUS-52): results from two multicentre, randomised, double-blind, placebo-controlled, parallel-group phase 3 trials
Mepolizumab for chronic rhinosinusitis with nasal polyps (SYNAPSE): a randomised, double-blind, placebo-controlled, phase 3 trial
Biologics for chronic rhinosinusitis
Clinical evaluation and diagnosis of aspirin-exacerbated respiratory disease
Related publications:
Efficacy and safety of dupilumab in patients with severe chronic rhinosinusitis with nasal polyps (LIBERTY NP SINUS-24 and LIBERTY NP SINUS-52): results from two multicentre, randomised, double-blind, placebo-controlled, parallel-group phase 3 trials
Mepolizumab for chronic rhinosinusitis with nasal polyps (SYNAPSE): a randomised, double-blind, placebo-controlled, phase 3 trial
Biologics for chronic rhinosinusitis
Clinical evaluation and diagnosis of aspirin-exacerbated respiratory disease
Guy's and St Thomas' Obstetric Medicine Service
Prof Catherine Nelson-Pearcy, Professor of Obstetric Medicine
Related publications:
Asthma in pregnancy
British Guideline on the Management of Asthma
Diagnosis and management of covid-19 in pregnancy
Related publications:
Asthma in pregnancy
British Guideline on the Management of Asthma
Diagnosis and management of covid-19 in pregnancy