Asthma patients 'dying needlessly'

Hampshire Chronicle: Medics are failing to spot key signs which point to patients not managing their condition well, such as excessive use of a reliever inhaler, a report said Medics are failing to spot key signs which point to patients not managing their condition well, such as excessive use of a reliever inhaler, a report said

Asthma patients are dying needlessly as a result of poor care , a damning new report has found.

Experts identified " major avoidable factors" in two thirds of asthma deaths examined.

Patients are receiving inadequate information, education and advice on managing their asthma, according to the document.

Meanwhile medics are failing to spot key signs which point to patients not managing their condition well.

These factors are leading to a large number of deaths which could otherwise have been prevented, the report says.

In the UK, three people die from asthma every day and every 10 seconds someone suffers from a potentially life-threatening attack.

Experts from the Royal College of Physicians (RCP) examined 195 asthma deaths, including 28 children.

They identified at least one "major potential avoidable factor" in 67% of the cases.

GP Dr Mark Levy, RCP's clinical lead for the report, said: " It is very sad that people are not aware that asthma can kill.

"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 that m any of the patients who died had excessively used their reliever inhalers in the months running up to their deaths - indicating that they were not managing their disease well.

Medics should have spotted that they were repeatedly prescribing these inhalers and taken action, the authors said.

Meanwhile one in 10 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% of those people who died following an asthma failed to call for help or obtain help during their attack and the vast majority of children died even before they reached hospital.

Dr Levy said: "It might be that in these cases people were complacent about their asthma and we feel that the majority of these people did not know what to do - they did not recognise the danger signs they did not know how or when to call for help."

He said that 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.

The report concluded: "The review found deficiencies in both the routine care of asthma patients and the treatment of attacks.

"In many instances neither doctors nor patients recognised the signs of deteriorating asthma; they also did not react quickly enough when these were seen."

The authors called for an end to "complacency" around asthma care.

Charity Asthma UK said that prescribing errors were detected in 47% of the deaths studied.

It said that it was "shocking" that experts identified "room for improvement" in 83% of the cases.

Kay Boycott, chief executive of the charity, said: "This confidential enquiry 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 the confidential enquiry showed that children fared worse than adults in multiple aspects of care, and fell well below expected standards in almost half of child deaths.

"Above all, we need leadership at every tier of the health system across the UK to challenge the complacency about asthma and prevent life threatening asthma attacks.

"Every 10 seconds someone has a potentially life threatening asthma attack and this report reinforces the need for vigilance in managing your - or your child's - asthma especially if you've recently had an attack, been in hospital or if your asthma is waking you at night."

The report, which is released to coincide with World Asthma Day, s ets out a series of recommendations for healthcare workers including the introduction of an electronic surveillance system to be set up to show doctors and pharmacists when people excessively use reliever medication and do not use enough preventative medication.

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

The authors also said that more must be done to educate people about their condition. Every health care organisation should have one named individual with a responsibility for asthma care, they added.

Dr Levy also said there were also pressures on prescribing costs.

"Doctors are trying to prescribe economically and not necessarily with the clinical efficacy," he said.

"In the National Health Service we have got costs issues so there are pressures right from the top to try and prescribe economically, now that doesn't mean doctors are being told not to prescribe effective medication, they are being told to prescribe medication which is effective and helping people."

In 2012, 1,242 people died from asthma. There are 5.4 million people in the UK who suffer from the condition.

Professor Mike Morgan, NHS England's national clinical director for respiratory services, said: "These statistics are a call to action for commissioners, health professionals and patients.

"Every patient should have a care plan which should be regularly reviewed and patients should be supported to manage their asthma, including effective inhaler technique and knowledge of their condition.

"Treatment should adhere to clinical and prescribing guidelines. In February last year, National Institute of Health and Care Excellence (Nice) produced a set of quality standards which make it clear that local commissioners should integrate services so that asthma sufferers receive a consistently high quality service from childhood to adulthood."

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