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Thousands may be on wrong asthma drugs

With one of the highest rates of asthma, the UK has around 5.4 million sufferers. Yet, according to a recent audit carried out by the charity Asthma UK, tens of thousands of people are not being prescribed the right medication for their condition. Not only did the audit find that many patients had been put on the wrong types of inhalers, but also that many medical staff were not picking up on the warning signs of asthma conditions that are heading out of control.

A good example of this is the prolonged use of reliever inhalers. Many patients are currently prescribed short-acting reliever inhalers to help manage their asthma. However, if the number of inhalers used in a year exceeds 12, then the patient’s condition should be deemed ‘not under control’ and another type of medication sought. In the audit of more that 500 GP practices, it was found that 5,000 patients had exceeded this number, 1,965 of them without being reviewed by a nurse or doctor.

A lack of specialist training has been cited as part of the problem, with many nurses themselves calling for better asthma training. It’s widely known that patients should be receiving more regular reviews of their condition to allow for early intervention, should it be necessary. However, if enough nurses aren’t being trained in this type of preventative medicine, then the situation for patients is unlikely to improve.

This latest audit backs up the findings of The National Review of Asthma Deaths published last year – the first report of its kind in the UK. It was found that in nearly half the cases studied, asthma sufferers did not receive any medical help during their final asthma attack. The report also showed that, although deaths linked to asthma are falling, there were still 1,242 fatalities in 2012, which is one of the highest death rates for the illness in Europe. And there is still complacency about how dangerous the condition can be – both amongst patients and clinicians.

Some of the key findings of this original report are alarming to say the least:

  • Standard of care received “less than satisfactory” in a quarter of cases where people died.

  • "Room for improvement" in care received by 83% of those who died.

  • Triggers for asthma attacks not documented in more than half of the cases and 57% not recorded as being under specialist supervision in the year before death.

  • Widespread under-use of preventer inhalers and excessive over-reliance on reliever inhalers.

  • 10% of those who died did so within one month of discharge from hospital following treatment for asthma; at least 21% had attended an emergency department at least once in the previous year.

  • Over half of those who died were being treated for mild or moderate asthma at the time, unaware of how serious their asthma really was.

  • 46% of deaths could have been avoided with better routine care.





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For me, what’s surprising is that this situation has been allowed to continue for so long. It does little to instil confidence in a system that has already been heavily criticised for its reliance on staff that are often under-trained and over worked. Patients should be able to feel confident that they are getting the right diagnosis and the right care and medication for that diagnosis. That’s really the least people should expect from their Health Service. So it’s imperative that the resources in terms of training are there to help make this happen. The findings here are even more worrying when you consider that many of these asthma patients are children. But surely more specialist staff is the best place to start, and would undoubtedly help to prevent many unnecessary deaths in the future.

Of course there is fierce competition within the NHS about how to distribute their stretched finances. However, it must surely make sense to focus more of those resources towards a condition with 5.4million sufferers where it has been found that 46% of deaths that occurred could have been avoided. Some effective preventative measures now may well save both lives and money in the future as acute problems and deaths reduce.

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