Complacency in asthma care leads to unnecessary deaths

POOR standards of care in the treatment of asthma are leading to unnecessary deaths according to a confidential enquiry from the Royal College of Physicians.

The National Review of Asthma Deaths (NRAD) found that nearly half (45 per cent) of patients included in the study who died from asthma did not receive medical help during their final asthma attack. Among asthma deaths, some 80 per cent of children under age 10 and 72 per cent of young people aged 10–19 died before they reached hospital.

The report is calling for improvements so that both patients and healthcare professionals are better able to recognise the signs of deterioration in asthma, and are better at acting quickly when faced with a potentially fatal asthma attack.

Among the main findings of the report, standards of care were judged less than satisfactory in a quarter of those who died and there was 'room for improvement' in the care received by 83 per cent. Triggers for asthma attacks had not been documented in more than half of the cases and 57 per cent of patients 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 and there was widespread under-use of preventer inhalers and excessive over-reliance on reliever inhalers.

Over half of those who died were being treated for mild or moderate asthma at the time and 10 per cent died within one month of discharge from hospital following treatment for asthma. At least 21 per cent had attended an emergency department at least once in the previous year. Just under 20 per cent of those who died were smokers and others, including many children, were exposed to second-hand smoke in the home.

The NRAD is calling for every hospital and GP practice to have a designated, named clinician for asthma services and for better monitoring of asthma control so that when loss of control is identified in a patient there is immediate action. It also recommends better education for doctors, nurses, patients and carers to make them aware of the risks and able to recognise the warning signs of poor asthma control and know what to do during an attack.

All patients should be provided with a personal asthma action plan (PAAP), which can help them to identify if their asthma is worsening and tell them how and when to seek help.

Dr Kevin Stewart, clinical director of the Clinical Effectiveness and Evaluation Unit (CEEU) at the RCP, said: "It’s time to end our complacency about asthma, which can, and does, kill. There are important messages in this report for clinicians, for patients and their families and for policy-makers.

"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. We can and we must do better."

Link

Why asthma still kills