Report calls for end to complacency among doctors, carers and patients, saying a quarter of sufferers receive unsatisfactory care
Sarah Boseley, health editor
The report found preventable factors in more than 70% of cases of asthma sufferers. Photograph: Linda Nylind for the Guardian
Children and adults are dying needlessly from asthma attacks, according to a report by experts published on Tuesday, which found that in a quarter of fatal cases patients had received less than satisfactory care.
Complacency around the disease – which kills about 1,200 people a year – has to end, says the report by the Royal College of Physicians.
In its confidential inquiry into a sample of 195 deaths for which detailed records were available, the college found that a quarter had received less than satisfactory care and there was room for improvement in 83% of the cases.
Complacency, said Dr Mark Levy, a GP and one of the authors of the report, was a fair word to use.
“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.”
Levy said there were failures by doctors, carers and the patients themselves, with clear signs that the asthma of some patients was not under proper control.
The patients who died tended to have relieved the symptoms of an asthma attack by over-using reliever inhalers, which open the airways and help them breathe but do not deal with the underlying problems.
“They don’t address the inflammation,” said Levy. “It’s like painting a rusty pipe.” In contrast, there was under-use of preventive inhalers.
Doctors failed to follow up people who were clearly at risk. One in 10 of those who died had been discharged from hospital less than a month earlier after treatment for asthma, and 21% had attended accident and emergency departments at least once in the previous year.
More than half who died were being treated for mild or moderate asthma – doctors and patients had not realised the seriousness of their condition.
But patients had not always helped themselves – 19% were smokers while others, including children, lived with people who smoked at home. Some patients had not collected their prescriptions for preventive treatments or did not go for regular asthma checkups.
“It’s time to end our complacency about asthma, which can, and does, kill,” said Dr Kevin Stewart, clinical director of the clinical effectiveness and evaluation Uunit at the college.
“There are important messages in this report for clinicians, for patients and their families and for policymakers. 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.”
The National Review of Asthma Deaths is the largest study ever done on the subject. It recommends that every hospital and GP practice should have a named doctor responsible for asthma services, who should be a champion for improvement in care.
Better monitoring of patients is needed, the report says, to ensure that immediate action is taken when a patient’s asthma ceases to be under control and doctors, nurses, patients and carers need better education to recognise the risks and know what to do during an attack.
Every patient should have a personal asthma action plan to help them recognise when the disease is worsening and seek help.
“This report shows how care has deteriorated since the last national analysis of asthma deaths in 2005,” said Professor Chris Griffiths from Queen Mary University of London, a member of the report steering group.
“These worrying statistics can and must be turned around in the next decade. Those of us who work in general practice must implement the recommendation to have a named clinician responsible for asthma in each practice.
“Despite facing huge challenges as we work to meet current NHS organisational change, we need to prioritise asthma care in order to reduce deaths in the UK.”