Asthma patients are missing vital annual reviews

A new review of GP data conducted by Asthma UK makes for an alarming reading, showing that over a million people suffering with the lung condition are not having vital annual check-ups – important in assessing if asthma medicine is being used in the correct way, to see if lung function has got better or worse, and to check if patient’s asthma inhalers are the most appropriate ones for them.

The new research conducted by Asthma UK discovered that 31% of asthma patients had not received an essential annual review to look at the suitability of their prescribed asthma medicine.

The charity analysed GP statistics from 2012/13 and found that 3,359,612 people in England were scheduled for an asthma review, however 1,025,539 patients had not attended.

Guidance published by the NHS advises all asthma patients to attend their yearly checks as well as keep an asthma action plan and have their inhaler technique looked at. For instance, GPs and asthma nurses need to see if the patient ‘test’ the device first, if the patient shakes the inhaler before using, is breathing out normally, holding the inhaler upright with lips sealed around it, using one actuation only per inhalation, and if the patient is holding their breath for 10 seconds (if possible).

Patients who aren’t using their inhaler correctly may find they are overusing the blue reliever inhaler because they are not sufficiently ingesting the drug to start with. Others find they may be using their relievers far more frequently than previously, and more often than not, these people are not bothering to use the brown preventer inhalers which are massively important in building a long-term improvement.

For example, it can take between 7 to 14 days for the brown preventer to build up its effect, or sometimes as much as six weeks, and will not give immediate relief of symptoms like the blue inhaler offers. The benefits of the brown inhaler build up over time and will decrease the chance of an asthma attack/symptoms occurring by slowly building resistance to triggers.

A recently conducted UK-wide National Review of Asthma Deaths found prescribing mistakes in almost half (47%) of asthma deaths and the quality of care could have been improved in a staggering 83% of the deaths.

The National Review also discovered that only 57% of these patients had received an annual asthma review in the last year of their life. From the other 43% that did have a review, many of these had not even included key components.

Dr Samantha Walker, Deputy Chief Executive of Asthma UK, was speaking on the finding that a quarter of people with asthma in the North of England had not had a review of their condition.

She said: “The fact that over a quarter of people with asthma in the North of England are not getting their medicines checked at their annual review is no doubt contributing to the rising NHS spend on asthma and putting people’s lives at risk. With the worrying scale of prescribing errors identified by the National Review of Asthma Deaths, it’s vital that doctors and nurses do everything they can to follow up with patients to review their medicines, especially as asthma can vary hugely over the year. We’re keen to understand where further improvements can be made to asthma care in the North of England so urge people with asthma to complete our survey www.asthma.org.uk/compareyourcare to find out how their care compares to national standards”.

Asthma deaths could be avoided – The importance of brown preventer inhalers

Preventer inhalers for the respiratory condition asthma usually comprise of a steroid drug and are used daily to prevent symptoms from developing by working to reduce inflammation in the airways. As the inflammation has subsided, there is less risk of the airways becoming narrow and causing symptoms like wheezing.

The brown preventer inhaler is usually taken twice a day. Your doctor may advise you to use the brown inhaler more often if you are experiencing a regular flare-up of symptoms. Medical Specialists™ Pharmacy have noticed a worrying trend of asthma patients very rarely or even not using their brown inhalers at all and over-using the blue reliever inhaler.

You should always remember it can take between 7 to 14 days for the brown preventer to build up its effect, or sometimes as long as six weeks, and will not give immediate relief of symptoms like the blue inhaler offers. Basically, the impact of the brown inhaler is built over time and will decrease the chance of an asthma occurring by slowly building resistance to triggers.

In fact, you may find your asthma is well controlled by regular use of the preventer and find you need to use your reliever inhaler less often, if at all.

This is particularly significant following a national review claiming that around two thirds of UK deaths from asthma in the UK — including nearly all cases where a child is involved – could have been averted if there was less complacency amongst doctors, carers and the patients themselves, with a quarter of sufferers receiving unsatisfactory care.

The report, led by the Royal College of Physicians, found a shocking number of needless deaths that experts described as “a tragic waste of life”.

Only Estonia and Spain has higher death rates than the UK in the Western world, and there are huge concerns about the increasing death toll. For instance, in 2012 there were 1,250 asthma related deaths – a 10% increase over the previous three years. The new review states 800 of those could have been prevented with better care.

The National Review of Asthma Deaths — the biggest single study looking into the circumstances involved with asthma deaths — examined 195 deaths within the UK. It was discovered that in about a quarter of the cases, care was not of a satisfactory standard and in 83% of cases, there was room for improvement.

Dr Mark Levy, a GP and one of the authors of the report, said ‘complacency’ was a fair word to describe the situation.

“We have known about the identifiable or preventable factors relating to asthma deaths since 1966,” he said. “The shocking and surprisingly sad thing about this report is that we still find preventable factors in over 70% of cases, some of which are pretty serious. For instance, 45% of those who died did not call or obtain help, which indicates that either these patients weren’t too worried about their asthma or they’d never been told how to recognise the danger signs.”

Those who died tended to over-use their blue reliever inhaler to subside the symptoms of an asthma attack as these inhalers help to open the airways for easier breathing. They do not treat the underlying problems however, and this is something many asthma patients do not realise.

“They don’t address the inflammation,” said Levy. “It’s like painting a rusty pipe.” Unsurprisingly, the study found an alarming under-use of the brown preventive inhalers.

The review has called for each hospital and GP practice around the UK to have a specified doctor in charge of asthma services and who should work at improving asthma care. In addition, patients need to be monitored more thoroughly according to the review, so that action is taken at the first instance if it is apparent that a patient’s asthma is no longer under control.

It is recommended that each asthma patient should keep a personal asthma action plan to help them realise when the condition begins to get worse and when to seek further help.

If you seek help from Medical Specialists™ for your asthma, you can be assured of an efficient and discrete service. We offer a wide range of both blue reliever inhalers, such as Ventolin Evohaler and brown preventer inhalers, such as Qvar Easi-Breathe.

Patient care is at the core of our aims and our GMC-registered doctors will carefully review your consultation to decide your suitability for that medication and then also assess the frequency of your orders with us thereafter. This is essential as if mentioned earlier, you are requiring too many relievers, it could be a sign of underlying problems with your asthma and we would recommend you see your own GP for further monitoring as you may need to undergo a lung function test. This is essential to determine if your asthma is getting worse or to check if your asthma is improving with treatment.