Asthma is the most common long-term condition, affecting about 5.4 million people in the UK (Asthma UK, 2018). What is less commonly known is how very deadly it is, with someone in the UK experiencing a potentially life-threatening asthma attack every 10 seconds (Asthma UK, 2018).
The National Review of Asthma Deaths (NRAD), commissioned by the Healthcare Quality Improvement Partnership on behalf of NHS England, systematically reviewed deaths from asthma over a 12-month period, from 1 February 2012, and subjected them to an in-depth and confidential enquiry involving multiple disciplines (Royal College of Physicians, 2014). The review investigated the individual circumstances surrounding these deaths, with the aim of decreasing this death rate.
For many years, the asthma death rate in the UK had been stagnant at around 1200 deaths per year, 90% of which were acknowledged to involve preventable factors. However, more than 5 years after the publication of the NRAD report, not only is the asthma death rate not declining, but it is no longer even stagnant, and is actually on the rise, having reached 1400 deaths in 2018 (The Pharmaceutical Journal, 2019).
Asthma deaths
England and Wales are facing the highest death rate from asthma seen in the last decade, with 12 700 people dying from asthma in the last 10 years—an increase of 33%, according to an Asthma UK analysis of data from the Office for National Statistics (2019) (The Pharmaceutical Journal, 2019). Asthma UK is now calling on the NHS to take urgent action on a situation it describes as ‘a lack of basic asthma care’; this comes only 5 years after the NRAD highlighted that two-thirds of asthma deaths in the UK could have been prevented with better basic care (Levy et al, 2014; The Pharmaceutical Journal, 2019).
Asthma care
Asthma care generally consists of the prescription and use of preventer, reliever and combination inhalers, as well as tablets, injections, surgery and other novel treatments for extremely severe cases (Foster, 2018; NHS, 2018). However, whether the patient is taught proper inhaler technique to ensure they are using their inhalers correctly, whether they have an asthma action plan to help them manage their condition and whether they have an annual asthma review with a nurse or GP are all highly variable.
Asthma standards
The NRAD had made 19 recommendations for improved asthma care to decrease preventable deaths in 2014; only one of these has been partially implemented 5 years since its report (Levy et al, 2018). Demonstrating the consequences of this inaction, asthma deaths increased by 8% between 2017 and 2018 (The Pharmaceutical Journal, 2019). Asthma UK has estimated that 60% of people living with asthma in England and Wales—about 2.9 million individuals—are not receiving the basic care recommended by national guidelines (The Pharmaceutical Journal, 2019).
Raising the bar
People with a written asthma action plan are four times less likely to be admitted to hospital for their asthma (Adams et al, 2000). Sadly, this research was published 19 years ago, and Asthma UK is still using it to try and get this point across, because no action is being taken to ensure an acceptable standard of asthma care.
Asthma action plans specify a patient's asthma triggers, as well as their daily routine, what their asthma should appear like when it is under control and how to know if it is not, including what specific steps to follow and whom to contact in this situation. Patients are taught to check in regularly with their action plan and even advised to keep a copy of it on their phone and/or fridge, for example, so it remains top of mind and easy to access.
Above all, it encourages patient empowerment, with health professionals arming those with asthma with the knowledge and tools they need, and the patients self-managing their condition, increasing their personal responsibility, daily action and, perhaps most importantly, their sense of control over their condition and life.
Conclusion
Despite asthma being a life-threatening condition, there is a great deal of complacency surrounding its management, among both health professionals and patients (Levy et al, 2014; Marsh, 2018). In fact, the NRAD demonstrated that both patients and health professionals had poor perceptions of asthma and its risk of death, in particular (Levy et al, 2014; Marsh, 2018).
Inhaler prescr iptions must be accompanied by discussions about proper technique, the establishment of an asthma action plan and a structured annual review by a health professional with specialist training in asthma (with closer monitoring of people at high risk of a severe asthma attack).
The notion that an individual nurse in the community cannot make a difference on their own is a dangerous one. The proactive action of each nurse will be necessary to shift the care culture and the perception of asthma and its management, both among health professionals and, importantly, patients themselves.