UK asthma patients dying due to poor basic care

Doctors failing to manage use of asthma inhalers says report. Picture: Getty
Doctors failing to manage use of asthma inhalers says report. Picture: Getty
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ASTHMA patients are dying needlessly as a result of poor basic care and a failure to recognise when life is at risk, a damning new report has found.

A National Review of Asthma Deaths, published today on World Asthma Day, highlights prescribing errors in 47 per cent of asthma deaths and room for improvement in the care received by 83 per cent of those who died.

The UK has one of the highest asthma death rates in Europe, with the latest data showing they are on the rise.

In the UK, three people die from asthma every day, and every ten seconds someone suffers from a potentially life-threatening attack.

In Scotland there were 89 deaths in 2012 and 6,080 emergency hospital admissions for asthma during 2012-13. There are currently 368,000 people (one in 14) receiving treatment for asthma north of the Border.

Experts from the Royal College of Physicians (RCP) identified “major avoidable factors” in two thirds of asthma deaths examined.

They said patients are receiving inadequate information, education and advice on managing asthma, while medics are failing to spot key signs pointing to patients not managing their condition well.

An examination of 195 asthma deaths across the UK, including 28 children, identified at least one “major potential avoidable factor” in 67 per cent of cases.

Dr Mark Levy, the RCP’s clinical lead for the report, called for an end to complacency in asthma care. “It is very sad that people are not aware that asthma can kill,” said Dr Levy. “Doctors, patients and their families failed to recognise life-threatening danger signs of asthma.

“We identified major avoidable factors in two-thirds of the people who died.”

The review found many of the patients who died had excessively used their reliever inhalers in the months running up to death – indicating they were not 
managing their disease well. Medics should have spotted that they were repeatedly prescribing these inhalers and taken action, the report authors said.

Meanwhile, one in ten of those who died had been admitted to hospital for an acute asthma attack within four weeks of their death.

The report found that 45 per cent of those who died following an asthma attack had failed to call for help, and the vast majority of children who died did not reach hospital before they passed away.

Dr Levy said three quarters of those who died did not have a personalised asthma plan which would have provided them with this information.

The experts said that half of those who died were being treated for mild or moderate asthma at the time – indicating that neither patients or medics realised how serious the cases were.

Kay Boycott, chief executive of the charity Asthma UK, said asthma should no longer be a “Cinderella” condition.

She said: “This confidential inquiry has identified prescribing errors of a frankly horrifying scale and is a damning indictment of current routine practice.

“In many of these cases the warning signs were ignored; past attacks are a clear risk factor for future attacks but more than two thirds of the people hospitalised in the month before they died didn’t get properly checked up afterwards.

“Parents of children with asthma will be especially horrified that children fared worse than adults in multiple aspects of care, and fell well below expected standards in almost half of child deaths.

The report sets out a series of recommendations, including the introduction of an electronic surveillance system showing when people excessively use reliever medication or do not use enough preventative medication.

And anyone who has been taken to hospital as an emergency should be reviewed within 48 hours.

Dr Levy also said there were pressures on prescribing costs.

“In the National Health Service, we have got costs issues so there are pressures right from the top to try and prescribe economically.”

Gordon Brown, national director of Asthma UK Scotland, said: “The Scottish Government must endorse the Asthma Priorities document to health boards as a national approach to improving asthma care in Scotland and assign resources to its effective implementation.”

Margaret Watt, chairwoman of the Scotland Patients’ Association, said more education on asthma was needed to prevent tragedies.

“There needs to be a lot more education and communication between health professionals and patients. Doctors must monitor their patients more often but patients and parents of young children need to be more alert to the dangers,” she said.

Last night, a spokeswoman for the Scottish Government said: “We will look closely at the key findings of this report to make sure that actions or learning is taken on board where appropriate. This will be part of a wider programme of work to deliver improvement locally.

“The Scottish Government continues to work closely with and support a number of initiatives in partnership with our third-sector partners, including work in primary care, to drive forward the national improvement of asthma services.”


Leaders: Asthma treatment | Elena Baltacha