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Unsafe asthma prescribing threatens 22,000 people’s lives

Long-acting relievers without preventative therapy raise risk of life-threatening attack

Louise Prime

Tuesday, 16 June 2015

Using long-acting asthma reliever inhalers without any preventative therapy puts people at risk of life-threatening asthma attacks – yet that is what thousands of people in the UK are doing, because of unsafe prescribing, according to new research from UK primary care.

Asthma UK said that using a long-acting reliever alone poses such a great danger to life in people with asthma that in the US it is subject to a ‘black box’ warning. But when the charity’s researchers recently analysed data from more than 500 general practices in the UK, they found that more than 22,000 people, including 2000 children, have been prescribed long-acting reliever inhalers in an unsafe manner.

The charity also found that national clinical guidelines are not being followed. Its analysis showed that nearly 100,000 people in the UK have been prescribed more than 12 short-acting relievers in a year, indicating that they need to use them more than three times a week on average, and so need their treatment to be reviewed. Asthma UK said this puts them at risk of a life-threatening asthma attack because their underlying inflammation is not being tackled, making them more likely to respond to triggers such as high levels of pollen or pollution.

GP Dr Mark Levy, author of The National Review of Asthma Deaths which last year found prescribing errors in nearly half of asthma deaths in primary care (47%), said: “Asthma UK’s report is welcome as it echoes the findings from the National Review of Asthma Deaths. There is widespread failure to recognise risk of attacks and therefore asthma death. Yet the reality is that deaths can be prevented when symptoms are managed effectively, with safe use of asthma medicines and in partnership with the patient.”

Asthma UK’s chief executive Kay Boycott commented: “It is simply unacceptable that the lives of people with asthma are being put at risk because of unsafe prescribing. The UK has some of the highest mortality rates for asthma in Western Europe and the levels of unsafe prescribing identified in our report today must be stopped. It is crucial that healthcare professionals review their systems and urgently recall patients who have been prescribed long-acting reliever inhalers on their own without a steroid preventer, or not as a combination inhaler. NHS bodies must ensure systems are in place to stop unsafe asthma prescribing from happening and implement all the recommendations from the National Review of Asthma Deaths to improve patient safety and end complacency in asthma care.”

She advised people with asthma not to panic, but to check whether their inhaler includes salmeterol, formoterol or tiotropium bromide as the only active ingredient and, if they are taking it without a steroid preventer inhaler, or not as a combination inhaler, to contact their GP straight away. She also said that anyone using their reliever inhaler more than three times a week who hasn’t had a recent review should contact their GP for an asthma review as soon as possible.

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