Blog entry by Rcgp Learning
1 May marks World Asthma Day, an annual event organised by the Global Initiative for Asthma (GINA). The event aims to raise awareness and improve asthma care around the world¹. It’s estimated that around 5.4 million people in the UK are currently receiving treatment for asthma, which amounts to around one in 12 adults².
According to Asthma UK, around three people die each day from asthma attacks and the UK has one of the highest death rates from asthma in Europe².
The National Review of Asthma Deaths (NRAD) was the first UK-wide investigation into asthma deaths, which looked into the 195 deaths that occurred between 2012 and 2013³. The review considered various areas of asthma care, such as use of NHS services and prescribing and medicines use. Another area that was investigated was ‘medical and professional care’ which found that out of the 195 people that died, only 44 (23%) had been provided with personal asthma action plans (PAAPs). For 84 people (43%), there was also no evidence that an asthma review had taken place in general practice within the last year before their death³.
The review also found that 61% of the deaths were of people that suffered from only mild or moderate asthma³. The NRAD concluded that their asthma was likely to have been poorly controlled and undertreated, which highlights the need for good control. While asthma is managed in both primary and secondary care, it is likely that patients will return to primary care to regularly monitor and review their asthma.
The 2016 guideline produced by the British Thoracic Society (BTS) and Scottish Intercollegiate Guidelines Network (SIGN) states that asthma is best monitored in primary care by an annual clinical review. For adults, they recommend that the following factors should be monitored and recorded⁴:
- Symptomatic asthma control
- Lung function assessed by spirometry or by peak expiratory flow (PEF)
- Asthma attacks, oral corticosteroid use and time off work since last assessment
- Inhaler technique
- Bronchodilator reliance
- Possession of and use of a self-management plan/personal action plan.
To monitor symptomatic asthma control, both the BTS/SIGN and NICE guidelines recommend using a validated questionnaire that uses directive questions, such as the Asthma Control Test or the Royal College of Physicians’ ‘3 questions’⁴’⁵. To help with identifying and managing any red flags that arise as a result of the clinical review, the NICE Clinical Knowledge Summary for asthma can be accessed here.
NICE have recently issued some updated guidelines for the management of asthma and you can access a summary of the updates here.
The RCGP offers various eLearning materials on asthma and the following resources are FREE to all healthcare professionals:
Asthma – 1 CPD credit
Common atopic presentations in primary care – 5 minute screencast on asthma
Single Inhaler Therapy for Asthma – 5 minute screencast
RCGP members can also benefit from access to the following resources:
EKU18 – Wheeze & Asthma in Young Children
EKU 2017.2 – Management of asthma
EKU 2018.2 – Diagnosis, monitoring and chronic asthma management
EKU podcasts – Asthma: introduction to Asthma, Asthma: NRAD report and Asthma Management Guidelines, Asthma: Management of the Asthma Patient
- Tiotropium in asthma: what is the evidence and how does it fit in?
- Over diagnosis of Asthma in Children in Primary Care
- Increased versus stable doses of inhaled corticosteroids for exacerbations of chronic asthma in adults and children
- Does inhaler choice matter?
- Systematic meta-review of supported self-management for asthma: a healthcare perspective
- Vitamin D supplementation to prevent asthma exacerbations
(1) The Global Initiative for Asthma (GINA). World Asthma day. Available from: http://ginasthma.org/wad/
(2) Asthma UK. Asthma facts and statistics. Available from: https://www.asthma.org.uk/about/media/facts-and-statistics/
(3) Royal College of Physicians. Why asthma still kills. The National Review of Asthma Deaths (NRAD). [May 2014]. Available from: https://www.rcplondon.ac.uk/file/868/download?token=JQzyNWUs
(4) British Thoracic Society (BTS) and Scottish Intercollegiate Guidelines Network (SIGN). British guideline on the management of asthma. . Available from: https://www.brit-thoracic.org.uk/document-library/clinical-information/asthma/btssign-asthma-guideline-2016/
(5) NICE. Asthma: diagnosis, monitoring and chronic asthma management (NG80). [November 2017]. Available from: https://www.nice.org.uk/guidance/ng80