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Review asthma patients regularly using bronchodilators, GPs told

The Royal College of Physicians has urged GP practices to urgently review control of asthma for any patient who has been prescribed more than 12 reliever inhalers in a year, after a study showed that patients had relied too heavily on reliever inhalers and were underprescribed preventer therapies in the year before they died of an asthma attack.

In a raft of measures aimed at preventing asthma deaths, the RCP also called for every GP practice to have a designated, named clinical lead in charge of training staff to manage acute asthma, and said all patients should have a personal asthma action plan detailing their triggers and explaining when to seek help in an emergency.

The RCP’s National Review of Asthma Deaths, commissioned by the Healthcare Quality Improvement Partnership, looked at the records of 195 patients who died of asthma in 2012.

Over half (58%) of patients who died were being treated for mild or moderate asthma, suggesting ‘they had poorly controlled undertreated asthma, rather than truly mild or moderate disease’, the report said.

In all, 39% of patients known to be on short-acting reliever therapy were prescribed more than 12 reliever inhalers in the year before they died, while 80% on preventer inhalers were issued fewer than the recommended 12 inhalers in the year running up to their final asthma attack.

The report also found over half of patients did not have a written asthma plan, or any record of potential triggers for an attack, while 45% did not seek any medical assistance during their final asthma attack.

Overall, the RCP said nearly a quarter of people who died as a result of an asthma attack in 2012 were receiving ‘less than satisfactory’ care in some way either in specialist clinics or primary care – and called for ‘an end to complacency’ from both the NHS and patients themselves about the risks of asthma and poor control of the condition.

Dr Kevin Stewart, a clinical director at the RCP said: ‘It’s time to end our complacency about asthma, which can, and does, kill.’

‘We haven’t paid enough attention to the importance of good routine asthma care by clinicians with the right training and experience and the part that patients themselves play in this. Too often we have also been slow to detect signs of poor asthma control and slow to act when these have been present, with tragic consequences for some families.’

National Review of Asthma Deaths - Why asthma still kills

Readers' comments (7)

  • This is an important study which makes it clear that asthma should be taken more seriously by both patients and doctors. However,
    1. 80% on preventer therapy had less than the recommended number in the previous year. This is down to patients not requesting it, presumably because they are not following advice,not doctors not prescribing appropriately. We cannot be expect edit o know if a patient is not requesting their inhaler.
    2. 45% did not seek medical assistance during their final attack suggesting that it was sudden and unexpected, not a failure of medical attention.
    3. 58% were being treated for mild or moderate asthma. His suggest

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  • ....This Suggests that the asthma attack was sudden and unexpected and does not prove that they were previously incorrectly diagnosed.
    4. In my experience patients do not turn up for asthma checks or flu jabs, even after several reminders.
    5. clearly patients who are using too many reliever inhalers, or have been recently discharged should be reviewed, but this is not specified by QoF and, in fact, the QoF targets have failed to improve the outcomes. In my view this is because the current boxes are ticked and both the patients and the doctors think the task is completed without any brain engagement.

    Please, Jeremy, get rid of QoF before more targets are shown to have unintended poorer outcomes.

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  • Vinci Ho

    The number of asthmatic patients who wrongly used salbutamol 2 puffs bd everyday and inhaled steroids on PRN basis , is significant .
    To make people understand uncontrolled asthma is fatal and using the right treatments , is paramount

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  • Did the report check the prescription was filled?

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  • This comment has been moderated.

  • Shouldnt need QOF to review these patients using too many relievers
    Talk to pharmacy if concerned inhalers are not being dispensed
    Then train yourself and nurses on inhaler technique again then roll out to patients

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  • yes yes...please always check technique recently Been asked as a nurse why i bother to check technique and why i carry spacers and placebos to all my homes/pt consultations
    DONT issue 2 relievers monthly
    Have good relationship with pharmacy to alert regular users of house despensing ..2 preventors to 1 salamol if salamol issued monthly i want to know why talk to patients .telephone, message need to get them in .Costs a problem sharing inhalers...and schools still have inhaler locked in a cupboard at play time in Jr school. PE teachers in high schools believe "no need for inhaler in cross country!!

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  • Vinci Ho

    Among the review's key findings were:

    The standard of care received was less than satisfactory in a quarter of cases where people died and there was "room for improvement" in the care received by 83% of those who died.
    Triggers for asthma attacks had not been documented in more than half of the cases and 57% were not recorded as being under specialist supervision in the year before death.
    Deficiencies were found in both routine care and in the treatment of attacks.
    There was widespread under-use of preventer inhalers and excessive over-reliance on reliever inhalers.
    10% of those who died did so within one month of discharge from hospital following treatment for asthma; at least 21% had attended an emergency department at least once in the previous year.
    Over half of those who died were being treated for mild or moderate asthma at the time; experts concluded that this was mostly because neither doctors nor patients themselves recognised how serious their asthma really was.
    Of those who died, 19% were smokers and others, including many children, were exposed to second-hand smoke in the home.
    Some patients had not collected their prescriptions for preventative treatment or did not attend regular asthma check-ups.
    Researchers found that clinicians and patients alike had become complacent about the illness.

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