The report by the National Review of Asthma Deaths supported findings from previous enquiries by providing further evidence that most asthma deaths are preventable and thus remedial. So are we failing in our care and management of asthma?
To put this into perspective, the number of deaths reported was 195 - significantly less than the figure quoted by asthma.org.uk of more than 1000 deaths, although one death is one too many. While this may reflect issues such as incorrect diagnosis it may also indicate that we do, for many people, get care right.
What we can take from this report are the key issues and steps to address them.
Asthma deaths occur not only in patients with severe and very severe asthma but across the board and are complicated by psychosocial issues, smoking, substance abuse and mental health problems. They are also more likely in hard to reach populations who don't engage with health service provision. Those who died had also attended A&E departments and 19 died within 28 days of hospital discharge. We need to actively flag up any contact with emergency care and work out ways to contact and review these people post-discharge.
We know is there is an over reliance on 'reliever' medication and poor adherence to 'preventer' medication. Six of those that ultimately died had picked up over 50 reliever inhalers and 80% had collected fewer than the expected 12 preventer inhalers, with 38% having collected fewer than four. This should trigger a warning flag that the patient needs urgent review and re-education.
As professionals we need to look at our level of expertise and use of guidelines. Only 23% of these patients had personalised asthma action plans. We know they work but still don't routinely use them.
The key is our ability to address our patients' knowledge, concerns and expectations, looking beyond asthma to what else is going on in patients' lives. To do this we may need novel ways of reaching those who often fail to engage with us, and must recognise that a one-size approach will never fit all.
Jane Scullion, respiratory nurse consultant