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Asthma deaths

Lives can be saved if complacency over asthma ends, says report

A national review into asthma deaths has revealed that there were 195 deaths in 2012-13 and evidence was found of excessive prescribing of reliever inhalers

Calls are being made to end the complacency around asthma care so that more is done to save patient lives after the largest ever national study of asthma deaths was published today.

Nearly half of those included in the study who died from asthma did not have any medical help during the final asthma attack, the confidential enquiry report from the Royal College of Physicians found.

About 1,400 people in the UK die from asthma each year, which is “unacceptable”, said the Royal Pharmaceutical Society, in response to the report. Better care and better access to medical help promptly enough during severe asthma episodes can improve patient outcomes significantly, it said.

“Pharmacists can do a lot to help with effective asthma management and monitoring through asthma consultations with patients or medicines use reviews (MURs),” the RPS added.

The report, “Why asthma still kills: the National Review of Asthma Deaths”, published on World Asthma Day (6 May 2014), found that nearly half (45 per cent, 87 patients) of the 195 people included in the study (see panel) who died from asthma did not have any medical help during the final asthma attack.

For 33 per cent of people (65 patients) there was no record of them seeking medical assistance and for 11 per cent (22 patients) who sought medical assistance help was not given in time.

The report found that 80 percent of the children under 10, and 72 per cent of young people aged 10 – 19 years died before they reached hospital.

Evidence of under-prescribing and widespread underuse of preventer medication was found, as was evidence of overuse of or over-reliance on short-acting beta agonist reliever inhalers and excessive prescribing of reliever medication.

The report recommends: “All asthma patients who have been prescribed more than 12 short-acting reliever inhalers in the previous 12 months should be invited for urgent review of their asthma control, with the aim of improving their asthma through education and change of treatment if required.”

Among 189 patients who were on short-acting relievers at the time of death, the number of prescriptions was known for 165, and 65 of these (39 per cent) had been prescribed more than 12 short-acting reliever inhalers in the year before they died, while six (4 per cent) had been prescribed more than 50 reliever inhalers. Those prescribed more than 12 reliever inhalers were likely to have had poorly controlled asthma.

Anna Murphy, RPS spokeswoman for respiratory medicine, said: “There are important messages in this report for clinicians, patients and policy makers. Improvements are needed so that both patients and healthcare professionals are better at recognising the signs of deterioration in asthma and are better at acting quickly when faced with a potentially fatal asthma attack.

“Identifying the avoidable risk factors, inhaler technique check, optimisation of treatment and help with understanding of individual asthma plans for patients should be offered routinely.”

For example, exposure to smoke is known to increase the risk to people dying from asthma. “Stop smoking services should be offered by pharmacists at every opportunity,” she said.

Pharmacy can cut hospital admissions for asthma

Alastair Buxton, head of NHS services at Pharmaceutical Services negotiating Committee, said: “We know that community pharmacy can make a real difference here. For example, a study on the Isle of Wight showed that MURs designed to help asthma patients use inhalers correctly reduced hospital admissions related to the condition by more than 50 per cent over a three month period.”

He thinks that community pharmacists should identify people with asthma whose medication records suggest they may need more help so they can be offered an MUR. “Community pharmacies could also be used to provide more support for people with asthma following discharge from hospital, but community pharmacy needs the cooperation of hospital colleagues in order that this group of patients can be identified for provision of a post-discharge MUR.”

The PSNC also believe that the Government should build on the MUR service by expanding the support available to asthmatics, by offering them an annual review at their community pharmacy, at a time convenient to them, with no need for an appointment.

Details of the report 

The National Review of Asthma Deaths was commissioned by The Healthcare Quality Improvement Partnership (HQIP), on behalf of NHS England, the Welsh Government, the Health Department of the Scottish Government and DHSSPS Northern Ireland, and managed by the Royal College of Physicians (RCP) in collaboration with professional and patient organisations. NRAD is the first national investigation of asthma deaths in the UK and the largest study worldwide to date. Between 2012/13, of the 3,544 deaths recorded with a mention of ‘asthma’ on the death certificate, 900 cases met the NRAD inclusion criteria and were screened for consideration by the NRAD team. Of the 276 cases then considered for detailed discussion by a multidisciplinary confidential enquiry panel, it was concluded that 195 deaths (71 per cent) were due to asthma.

 

Citation: The Pharmaceutical Journal DOI: 10.1211/PJ.2014.11138137

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  • Man with an inhaler. (Marin Conic/Dreamstime.com)

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