Charity ‘deeply concerned’ thousands missing out on essential care and annual asthma review

By Ella Pickover, Reporter5th May 2021News EnglandAsthma, Coronavirus / Covid-19, Long Term Care / Conditions, Lung Disease / Respiratory Health, News England

Hundreds of thousands of people at high risk of an asthma attack may have missed out on essential care due to the coronavirus pandemic, a charity has estimated.

Asthma UK has raised concerns that many people at highest risk of potentially fatal attacks have not had their annual review since the start of the pandemic.

It comes as a safety watchdog said that more must be done to prevent potentially fatal asthma attacks in children.

The Healthcare Safety Investigation Branch made a series of recommendations after reviewing the case of a near-fatal asthma attack in a five-year-old boy.

Asthma UK said it was “deeply concerned” that 1.3 million people in the UK with asthma who are at high risk of asthma attacks had missed out on a face-to-face annual asthma review due to the coronavirus pandemic.

The charity has estimated that almost a quarter (24%) of people with “uncontrolled symptoms” of asthma have not had a face-to-face asthma review in the last year, according to a poll of 12,000 people with the condition conducted last year.

This equates to around 1.28 million people, the charity said.

While some of these people received remote consultations, Asthma UK has estimated that 623,000 people across the UK who have symptoms of uncontrolled asthma had no annual asthma review at all in the last year.

Symptoms of uncontrolled asthma include using a reliever inhaler three times a week or more or waking in the night feeling breathless, with a cough, tight chest or wheezing.

The charity’s new report, released to mark World Asthma Day, also suggests that 3.5 million people with asthma have not received all elements of basic asthma care such as an annual review, an inhaler technique check and having a written asthma action plan.

It has called on GPs to prioritise reviews of those with uncontrolled symptoms.

Dr Andy Whittamore (pictured), clinical lead at Asthma UK and the British Lung Foundation, said: “It is deeply concerning that so many people including some of the most at risk of an asthma attack are not receiving any basic care which could keep them well and out of hospital.

“Everyone working in the NHS is trying their hardest in these unprecedented circumstances but it is still vital that everyone with asthma gets the care and support they need to avoid a potentially life-threatening asthma attack.”

Alison Cook, director of external affairs at Asthma UK and the chairwoman of the Taskforce for Lung Health, added: “The fact that so many people living with asthma are still not receiving the support and care they need is unacceptable.

“Although remote care can be helpful for many people in supporting them with their asthma, for those with uncontrolled symptoms, it is vital that access to face-to-face care is maintained.”

Meanwhile a team of HSIB investigators reviewed the case of the child who, in July 2019, had a near-fatal asthma attack and needed seven weeks of hospital care, including 13 days in intensive care.

They found that the boy had complex and varying health needs and difficulty adhering to medicine schedules.

And the HSIB report also points to a “lack of capacity” in the respiratory outpatient clinic at the child’s local hospital meant that the youngster waited “much longer” than he should have done between appointments.

After reviewing the case, investigators looked at wider issues surrounding asthma care.

A major review of asthma deaths in 2014 made 19 recommendations, 12 of these would have been relevant in the case examined, but HSIB said that only one has been implemented nationally to date.

HSIB urged the NHS to review the recommendations from the National Review of Asthma Deaths to ensure the implementation of recommendations that are outstanding.

Meanwhile it highlighted a “general lack of understanding about the potential seriousness of asthma” as it called on Public Health England to develop resources for young people and their parents to raise awareness and enable them to self-manage asthma more effectively.

A number of the other findings of the case include:

Limited communication between health services and schools.
The combination of paper and electronic health records means there could be “inconsistent and incomplete” transfer of information about a child’s condition and treatment.
Family doctors were unable to identify that the child was at increased risk of asthma attacks because there was no correlation of “red flag” events including: the number of times a patient had sought emergency care, a lack of improvement of symptoms and insufficient inhaled corticosteroid prescriptions.

“On average, three people die from an asthma attack in the UK every day,” said HSIB chief investigator Keith Conradi.

“It is a complex condition characterised by acute episodes of poor health.

“It can be incredibly distressing for children and their families and, as we saw in our case, the ambiguity over an asthma diagnosis only compounds the confusion and anxiety.”

Dr Jen Townshend, a consultant paediatrician who advised on the HSIB investigation said: “Outcomes for children and young people with asthma in the UK continues to be amongst the worst in the developed world and twice as bad as the next worst country in Europe.

“As a result, many children are living with intrusive and unnecessary asthma symptoms and sadly every year children and young people continue to die from asthma.

“In many cases these deaths are preventable.

“The HSIB report reinforces the findings from the 2014 National Review of Asthma Deaths and highlights specific areas for improvement with clear lines for accountability to ensure these recommendations are addressed.”

An NHS spokesperson said: “The NHS is already implementing the recommendations of the report with improved asthma care at the heart of the NHS Long Term Plan, which committed to improving asthma outcomes for children and young people.

“The NHS spends around £1 billion a year treating and caring for people with asthma and helping them get back to good health, while national experts are working on developing a new national framework to be implemented across the country to further improve care for children and young people suffering from asthma.”