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GPs go forth

Up to 22,000 asthma patients could be at risk from lack of preventative treatment

GP experts have recommended practices review their prescribing of asthma inhalers after a large-scale study suggested up to 22,000 patients in the UK may be going without preventative treatment.

Building on a smaller study from last year, which suggested over half of deaths from asthma attacks were in people with poorly controlled asthma, Asthma UK has analysed data for 95,000 UK patients finding over 400 were prescribed long-acting beta agonists (LABAs) or long-acting muscarinic antagonists (LAMAs) without also getting an inhaled corticosteroid (ICS) inhaler.

Extrapolated to the total asthma UK population this could mean over 22,000 patients are in the same boat, the charity said.

The study, which looked at patient data from 500 GP practices spanning 2010 to 2013, also found almost 2,000 of the patients had been given more than 12 short-acting bronchodilators in a year without being reviewed to find out why their asthma control is poor. Asthma UK said this could represent around 100,000 of the total population with asthma, if scaled up.

According to last year’s report, prepared by the Royal College of Physicians, this group is the most at risk from dying of an asthma attack, often because of a lack of adequate preventer therapy and poor self-knowledge about triggers.

The Primary Care Respiratory Society UK (PCRS-UK) said the new figures represented a very small minority of patients – just 0.4% and 2.0% of the total 5.4m patients being treated for asthma, respectively – and that ‘the vast majority of people with asthma are therefore receiving appropriate medication’.

However it urged GPs to make sure their patients were being treated in line with the gold-standard asthma guidelines from the British Thoracic Society and Scottish Intercollegiate Network (BTS/SIGN), as well as licensing regulations.

PCRS-UK chair Dr Stephen Gaduzo, a GP in Stockport, said some patients prescribed a LAMA or LABA alone in the study may have overlapping COPD and asthma, and therefore have been prescribed them for the COPD component. Alternatively, he said that while most patients with asthma are on combination inhalers, ‘a few could be receiving separate components and may have stopped taking ICS’.

He said practices should use clinical software ‘to identify these patients and conduct a structured review with them’.

He said: ‘Patient safety is paramount and PCRS-UK regards any prescribing that is not line with guideline recommendations and licensed indications with grave concern.

‘We continue to urge all practices to review their use of asthma medication to ensure that it is in line with the BTS/SIGN Asthma Guideline and safety guidance from the Medicines and Healthcare products Regulatory Agency (MHRA).’

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Readers' comments (5)

  • Is it the GP's lack of knowledge or effort that the problem or lack of awareness on patient's side?

    At my practice we always have problem with asthma Pts as they don't respond to invitation letters (sent x3 each year) and even when we see them, many would happily ignore the advice and live off salbutamol (I want x3 INH a months) and continue to smoke.

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  • Vinci Ho

    As I said in the past , it is a common pitfall that patient takes short acting beta 2 agonist consistently everyday e.g. twice a day and uses inhaled steroids PRN, on required , even they have been educated in the past . Would like to know the prevalence of this misunderstanding ......

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  • GP’s crap at XXXX (add your favourite disease du jour).

    It is seldom as simple as that. Of my asthma and COPD patients there are those that persistently request early (often very early) SABA inhalers despite being told time and time again that they should be using their ICS rather than SABA.

    It’s like banging your head against a brick wall. “Only me blue inhaler works doc!” Then goes off outside for a quick fag.

    “Not going to give me a script? OK am off the AEU/OOH to slag you off and get a new inhaler. Oh and complaint in its way“.

    Ideas Asthma UK?

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  • Agree with all the above!
    Sick of hearing "GPs need more education....." Add pressure group of the day.

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  • Anyone not behaving I dispense salbutamol as 1 inhaler per prescription to get them in . Pitfall is they then use up their childs 'free ones '

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