Royal College of Physicians - Complacency in asthma care must end, says first confidential enquiry report from Royal College of Physicians
6 May 2014 10:58 AM
Asthma is still killing people. The confidential
enquiry, the National Review of Asthma Deaths (NRAD), is calling for an end to
complacency around asthma care so that more is done to save
lives.
This first confidential enquiry report from the Royal
College of Physicians (RCP),Why asthma still kills, published today on World
Asthma Day, found nearly half (45%, 87 patients) of those included in this
study 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 NRAD 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.
The
NRAD was commissioned by the Healthcare Quality Improvement
Partnership (HQIP) and managed by the RCP in collaboration with
professional and patient organisations. The NRAD looked at the circumstances
surrounding death from asthma in order to identify patterns and trends in the
care received by patients.
Improvements are needed so that both patients and
healthcare professionals are better at recognising the signs of deterioration
in asthma, and are better at acting quickly when faced with a potentially fatal
asthma attack.
Findings from the NRAD
include:
- The
standard of care received was less than satisfactory in a quarter of those who
died and there was ‘room for improvement’ in the care received by
83% of those who died.
- Triggers for asthma attacks had not been documented in
more than half of the cases and 57% were not recorded as being under specialist
supervision in the year before death.
- There were deficiencies in both routine care and in the
treatment of attacks.
- There was 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; experts concluded that this was mostly because
neither doctors nor patients themselves recognised how serious their asthma
really was.
- 19%
of those who died were smokers and others, including many children, were
exposed to second-hand smoke in the home.
- Some patients had not collected their prescriptions for
preventative treatment or did not attend regular asthma
check-ups.
Recommendations made by the NRAD
include:
- Every hospital and GP practice should have a designated,
named clinician for asthma services.
- Better monitoring of asthma control; where loss of
control is identified, immediate action is required including escalation of
responsibility, treatment change and arrangements for
follow-up.
- Better education is needed for doctors, nurses, patients
and carers to make them aware of the risks. They need to be able to recognise
the warning signs of poor asthma control and know what to do during an
attack.
- All
patients should be provided with a personal asthma action plan (PAAP), which
can help them to identify if their asthma is worsening and tell them how and
when to seek help.
Dr Kevin Stewart, clinical director, Clinical Effectiveness and Evaluation Unit(CEEU) at the RCP
said:
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.
Notes to editors
For
further information please contact Hannah Bristow, communications officer,
Royal College of Physicians hannah.bristow@rcplondon.ac.uk; 020 3075 1447 or 07854 303
784.
NRAD is the largest ever national study of asthma
deaths. It is not a prevalence study: it did not look at how many people died
of asthma. Rather, the cases selected for review by the panels were those most
likely to have died from asthma when looking at the death certification with a
mention of ‘asthma’ in the first part of the death
certificate.
During the data collection for the NRAD 3,544 deaths
were recorded with a mention of ‘asthma’ on the death certificate.
Of these, 900 cases met the NRAD inclusion criteria and were screened for
consideration by the NRAD team; 276 cases were then considered for detailed
discussion by a multidisciplinary confidential enquiry panel. Of the 276 cases,
it was concluded that 195 deaths (71%) were due to asthma.
The Healthcare
Quality Improvement Partnership (HQIP) is led by a consortium of
the Academy of Medical Royal Colleges, the Royal College
of Nursing andNational Voices. The National Review of Asthma
Deaths was commissioned by HQIP on behalf of NHS England, the Welsh Government,
the Health Department of the Scottish Government and DHSSPS Northern Ireland.
Further information is available at www.hqip.org.uk