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Asthma still kills due to ‘complacency’

Nurse lead for asthma ‘needed’ for every CCG

Jo Carlowe

Tuesday, 06 May 2014

Asthma is still killing people due to the complacency of medical staff and patients. 

The first confidential enquiry report from the Royal College of Physicians (RCP), Why asthma still kills, published today on World Asthma Day, has found that nearly half (45%, 87 patients) of those who died from asthma did not have any medical help during the final asthma attack.

For 33% of people (65 patients) there was no record of them seeking medical assistance and for 11% (22 patients) help was not given in time.

The National Review of Asthma Deaths (NRAD), run by a consortium of asthma professional and patient bodies, led by the Royal College of Physicians, looked into the circumstances surrounding deaths from asthma from 1 February 2012 to 30 January 2013. 

It found that 80% of the children under 10 (8/10), and 72% of young people aged 10–19 (13/18) died before they reached hospital.

In fact, of the asthma deaths examined in this report, 65% had major factors that could have been avoided. Moreover, 58% of people who died were being treated, not for severe asthma, but for either mild or moderate asthma.

The quality of routine care was assessed as inadequate in 62% of cases, and the panels concluded that there may have been a lack of specific asthma expertise in 17%.

Potentially avoidable factors identified included:

  • In 59% of deaths, clinicians in primary care failed to adhere to the BTS/SIGN asthma guideline.
  • For 43% of patients, there was no evidence that the patient had had an asthma review in general practice in the last year before death.

The confidential enquiry, is calling for an end to complacency around asthma care so that more is done to save lives. Included in its recommendations is the need for every GP practice to have a designated, named clinician for asthma services and for all patients to be provided with a personal asthma action plan (PAAP). 

“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,” said Dr Kevin Stewart, clinical director, Clinical Effectiveness and Evaluation Unit (CEEU) at the RCP.

The message is echoed by other professional bodies. 

The Association of Respiratory Nurse Specialists (ARNS) and Royal College of Nursing (RCN) are calling for a “step change” in the way asthma is treated and understood.

Dr Peter Carter, Chief Executive & General Secretary of the RCN said: “The tragic waste of life outlined in this report is shocking. The death of every one of these people is a tragedy for their families and friends and for the wider community, as most could have been helped with consistent access to the best care.

“Specialist nurses can help people living with asthma to manage and understand their condition, keeping them well and out of hospital. Sadly this report shows that respiratory illnesses are often overlooked as a poor relation to other public health issues.”

He added: “A step change in treatment is needed. Everyone with asthma should have a personal treatment plan and a clear idea of what they can do to manage their condition as well as knowing when and how to call for help.

“Unmanaged, asthma too often proves fatal, and the NHS must focus on helping patients to understand their condition better and to use their medication effectively. Without proper support, flare ups can too easily become emergencies and potential tragedies.”

The Royal College of Nursing and Association of Respiratory Nurse Specialists support the recommendations made by the national review. As part of the review, the two organisations are calling for the following specific changes:

  • Investing in education and support for non-specialists who encounter respiratory illnesses regularly, for example Practice Nurses
  • Introducing a nurse lead for asthma in every Clinical Commissioning Group.

Rebecca Sherrington, Chair of the Association of Respiratory Nurse Specialists, said: “It will take a co-ordinated effort to ensure that there are enough specialist nurses, and enough training for all other clinical staff. Not delivering these improvements is simply not an option if we are to prevent more individuals dying needlessly.”

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