More than 100,000 people with asthma in the UK are at risk of having a potentially fatal attack because GPs are not prescribing them the right medication, a charity for sufferers warns today.
An estimated 22,000 people, including 2,000 children, are in danger because they are using long-acting reliever inhalers on their own rather than with a steroid preventer as they should be, according to a report by Asthma UK. That poses a danger because the reliever helps to improve the patient’s breathing but not treat the underlying inflammation that causes flare-ups of asthma.
“This leaves the airways of people with asthma inflamed and more likely to react to triggers such as pollen or pollution, putting them at risk of a potentially life-threatening asthma attack,” Asthma UK said. The charity urged doctors to check what drugs their asthma patients are on, and urgently recall those who have been given only the long-acting inhaler and give them the preventative drug to take, too.
The way such patients are taking their medication poses such a risk that in America it would carry a “black box warning”, which is the most serious alert the authorities can issue before ordering that a drug can no longer be sold.
A further 100,000 asthmatics are also at risk because they rely too much on short-term reliever inhalers to tackle their constricted breathing and have not been advised by a health professional how to keep their condition under control. Doctors should realise that anyone who used a usually-blue-coloured reliever inhaler three times a week, or who is prescribed 12 inhalers a year, had poor control of their asthma and needed to have their treatment reviewed.
The charity’s findings are based on an analysis of patient records from 520 GP surgeries. They back up previous research that showed family doctors’ failure to prescribe the right drugs contributed to the UK having the third highest death rate in Europe from asthma.
The death rate in the UK was 1.6 per 100,000 of population, behind Estonia (3.1) and Spain (1.8). Around one in 11 Britons – some 5.4m people – have asthma, which is more than in any other European country. It kills about 1,250 people a year, not all of whom suffer a severe form of the disease.
“It is simply unacceptable that the lives of people with asthma are being put at risk because of unsafe prescribing,” said Kay Boycott, Asthma UK’s chief executive. “The UK has some of the highest mortality rates for asthma in western Europe and the levels of unsafe prescribing identified in our report today must be stopped.”
A major inquiry into asthma deaths in Britain last year by the Royal College of Physicians identified the prescription and use of medicines as key factors. It looked at 189 patients who had been on short-acting relievers when they died. Of 165 whose prescriptions were known, 65 (39%) had been prescribed the inhaler more than 12 times in the 12 months before their death. “Those prescribed more than 12 reliever inhalers were likely to have had poorly controlled asthma,” it reported. All such patients should undergo an urgent review of their asthma control, it recommended.
The national review of asthma deaths also found evidence of underprescribing of preventer medication. However, although asthmatics should usually receive 12 such inhalers a year to control their condition, 49 (38%) of 128 patients who had died had been given fewer than four and 103 (80%) fewer than 12.
“The UK has one of the highest rates of asthma prevalence, hospital admissions and mortality in the world,” said Prof Russell Viner, officer for health promotion at the Royal College of Paediatrics and Child Health.
The fact that up to 2,000 children are using only a reliever without a preventer “means not only will it fail to treat the underlying cause, but it puts these children at increased risk of death. This is simply not acceptable and must change,” Viner added.
