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.’