The national review of asthma deaths: what did we learn and what needs to change?

Abstract

Key pointsThe 2014 UK National Review of Asthma Deaths identified potentially preventable factors in two-thirds of the medical records of cases scrutinised45% of people who died from asthma did not call for or receive medical assistance in their final fatal attackOverall asthma management, acute and chronic, in primary and secondary care was judged to be good in less than one-fifth of those who diedThere was a failure by doctors and nurses to identify and act on risk factors for asthma attacks and asthma deathThe rationale for diagnosing asthma was not evident in a considerable number of cases, and there were inaccuracies related to the completion of medical certificates of the cause of death in over half of the cases considered for the UK National Review of Asthma DeathsEducational aimsTo increase awareness of some of the findings of the recent UK National Review of Asthma Deaths and previous similar studiesTo emphasise the need for accurate diagnosis of asthma, and of the requirements for completion of medical certificates of the cause of deathTo consider areas for improving asthma care and prevention of attacks and avoidable deathsSummaryDespite the development and publication of evidence-based asthma guidelines nearly three decades ago, potentially preventable factors are repeatedly identified in studies of the care provided for patients who die from asthma. The UK National Review of Asthma Deaths (NRAD), a confidential enquiry, was no exception: major preventable factors were identified in two-thirds of asthma deaths. Most of these factors, such as inappropriate prescription and failure to provide patients with personal asthma action plans (PAAPs), could possibly have been prevented had asthma guidelines been implemented.NRAD involved in-depth scrutiny by clinicians of the asthma care for 276 people who were classified with asthma as the underlying cause of death in real-life. A striking finding was that a third of these patients did not actually die from asthma, and many had no recorded rationale for an asthma diagnosis.The apparent complacency with respect to asthma care, highlighted in NRAD, serves as a wake-up call for health professionals, patients and their carers to take asthma more seriously. Based on the NRAD evidence, the report made 19 recommendations for change. The author has selected six areas related to the NRAD findings for discussion and provides suggestions for change in the provision of asthma care. The six areas are: systems for provision and optimisation of asthma care, diagnosis, identifying risk, implementation of guidelines, improved patient education and self-management, and improved quality of completion of medical certificates of the cause of death.

Managing the pediatric patient with refractory asthma: a multidisciplinary approach

“…The technique required to use a dry powder device effectively is prohibitive in many cases, with over 50% of children demonstrating serious errors in technique on assessment 19. Children and families should be educated about asthma and specifically the “how”, “why”, and “when” of the asthma medications they are prescribed 7. Finally, all patients and carers must be given an individualized asthma action plan that details current treatment, how to recognize an exacerbation (including deterioration in peak flow values), and when to seek appropriate medical help 7.…”

“…It is associated with 80% of asthma deaths7 and is probably the most influential contributor to poor asthma control in children 22. Satisfactory adherence is defined as the administration of at least 80% of prescribed doses 23…”

“…The European Respiratory Society and American Thoracic Society recommend referral to a respiratory specialist when a child is prescribed high dose inhaled steroids (800 μg/day budesonide equivalent)9 because specialized assessments and interventions are necessary to allow the identification and management of DA. Furthermore, the NRAD UK identified that 20% of asthma deaths were in patients who met the criteria for referral for specialist respiratory assessment, but had not been referred 7. It is important to note that there should be no complacency about the treatment of DA; it is not a benign condition, and death may result if modifiable factors are not rectified.…”

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“…Во многих исследованиях показано, что даже интермиттирующая астма может при-водить к обострениям, подчас жизнеугрожающим. Так, 9% из 155 погибших от БА в Великобритании имели легкую форму заболевания [17].…”

Fluticasone furoate/Vilanterol 92/22 μg once-a-day vs Beclomethasone dipropionate/Formoterol 100/6 μg b.i.d. in asthma patients: a 12-week pilot study

“…According to the World Health Organization asthma regards 300 million people worldwide, with prevalence data ranging from 1 to 18% in the adult population and 10-15% in children. The increase of hospitalizations and deaths due to asthma [2] justi ies the importance of its correct diagnosis and therapeutic management. The underlying mechanism responsible for asthma is the excessive presence and activation of in lammatory cells within the mucosal, muscular and vascular structures of the airways, which cause the release of in lammatory mediators and the remodeling of the airways.…”