Appoint named asthma lead to save lives, practices told

Named clinical leads for asthma in general practice and an overhaul of GP prescribing are needed to help save hundreds of lives each year, an inquiry has recommended.

The inquiry found complacency among patients and clinicians over the risks of asthma (Photo: JH Lancy)
The inquiry found complacency among patients and clinicians over the risks of asthma (Photo: JH Lancy)

Every practice and hospital should have a designated, named clinician for asthma services, responsible for formal staff training in the management of acute asthma, according to the review by the Royal College of Physicians (RCP).

Its confidential inquiry into asthma deaths found two thirds of 195 cases examined were avoidable.

Recommendations to practices included improved monitoring of patients who had lost control of their symptoms, after experts found over a third of people who died were prescribed more than 12 reliever inhalers in the year before their death.

Across the NHS, red flags to intervene were missed, prescribing was inadequate and patients were not followed up after hospital admission, the inquiry found.

Dr Kevin Stewart, clinical director of the Clinical Effectiveness and Evaluation Unit at the RCP, said: 'It’s time to end our complacency about asthma, which can, and does, kill.'

Avoidable deaths

Why Asthma Still Kills identified potentially avoidable factors in routine asthma care, on-going supervision and monitoring in 137 out of 195 (70%) cases in primary care in the year before death.

Experts identified factors that could have avoided deaths relating to how clinicians implemented asthma guidelines in 46% of the 195 deaths examined.

Around a fifth (21%) of people who died had attended A&E with asthma in the past year, the majority of whom more than once.

Only 24% of those seen in primary care in the year before they died had a personalised action plan, despite this being incentivised through QOF. Over two thirds of patients hospitalised in the month before they died were not reviewed afterwards.

Experts also found an over-reliance on reliever inhalers and an under-use of preventer inhalers.

Computer prompts needed

Although 86% of those who died were receiving inhaled corticosteroids as single agents or in combination with long-acting beta agonists, 80% had received fewer than 12 prescriptions in the past year, and 14% fewer than four prescriptions.

In contrast, over a third (39%) of those using short-acting beta agonists had more than 12 prescriptions in the year before they died.

The inquiry recommended that computer prompts in GP systems should alert clinicians to over- and under-use of asthma medications that could indicate a patient is at greater risk of an attack, and that such patients should be reviewed.

Dr Mark Levy, a London GP and clinical lead for the inquiry, said: 'I think GPs should be changing the way that they're prescribing for asthma, identifying those people who've got poorly controlled asthma from excess requirements of reliever medication.

'Asthma reviews, which are done in primary care, must be done by someone who was trained to do this.

'GPs and nurses looking after people with asthma, need to be familiar with the risk features, which should alert them someone's asthma is at risk.'

Kay Boycott, chief executive of Asthma UK, said: 'This confidential enquiry has identified prescribing errors of a frankly horrifying scale and is a damning indictment of current routine practice.'

Dr Stephen Gaduzo, chair of the executive committee for the Primary Care Respiratory Society, said the 'landmark' report had important lessons about asthma care. 'GP practices need to be supported and incentivised to improve the quality of routine asthma care so that lives can be saved.'

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