Asthma patients deserve better care

The 2016 Asthma UK annual asthma survey has produced some shocking findings. There are 5.4 million people in the UK diagnosed with asthma, but we found that two-thirds were not receiving the basic care that they need in order to stay well.

This is worrying in the context that the majority of those surveyed found their care satisfactory or excellent although responses suggested that 82% had poorly controlled asthma (defined as having symptoms or using their reliever three or more times a week, or any night waking due to asthma).

Basic care in the form of an annual asthma review, inhaler technique check and a written asthma action plan are well recognised as being key factors in preventing asthma symptoms and deaths. Complacency around asthma symptoms still exists and both patients and clinicians need to do more to identify and address excessive symptoms or reliever inhaler use.

Our survey showed that people with uncontrolled asthma were twice as likely to miss work or school and twice as likely to require hospital care.

In 2014, the National Review of Asthma Deaths revealed that two-thirds of deaths resulting from asthma were preventable by providing the basic elements of care. It also highlighted that deaths were often in people with mild to moderate asthma rather than severe asthma.

GPs, asthma nurses and community pharmacists need to work in partnership with people with asthma. Simple things that we should all do include:

• Educate people with asthma by signposting them to information, such as that available at Asthma UK (www.asthma.org.uk/advice) for more information about their asthma and what they can do to stay well. Twitter, Facebook pages and our Helpline provide added support.
• Educate people about the relationship between symptoms, inflammation and risk of asthma attacks and deaths. Uncontrolled asthma needs assessment.
• Encourage people to take preventative medicine as prescribed. Checking adherence and inhaler technique at every opportunity to optimise management is key to treating the inflammation that causes symptoms.
• Ensure the patient has a written asthma action plan. Having such a plan can reduce the chances of someone with asthma requiring admission to hospital by a factor of 4, yet less than 50% of people have been given one.
• Encourage attendance at an annual asthma review (more often if symptomatic).
• Monitor inhaler use. Recent British Thoracic Society/Scottish Intercollegiate Guidelines Network asthma guidelines suggest reviewing everyone who uses one reliever inhaler in a month for their asthma. Poor adherence to preventer medication is an important cause of poor asthma control.
• Effective communication with the person with asthma and with other members of the healthcare team, especially where action is needed.
• Make better use of existing and new technologies to provide safe, effective and convenient care for people with asthma, such as safety alerts on clinical IT systems, smartphone technology, and electronic reminders.

Asthma UK also has a health professional network and we encourage pharmacists to sign up at https://www.asthma.org.uk/professionals/sign-up/ for updates about asthma. Education and support for people providing asthma care can be found at Education for Health (https://www.educationforhealth.org/
)
and the Primary Care Respiratory Society UK
(
https://pcrs-uk.org/
).

Andy Whittamore

Clinical lead

Asthma UK