Abstract
The UK NRAD, the largest prospective review of asthma deaths world wide, investigated 195 asthma deaths between February 2012 - January 2013. Aim: To identify potential avoidable factors and make recommendations to improve asthma care. Method:900 cases were selected from 3544 death certificates mentioning asthma; available data for 31%(276/900) of cases were included in the confidential enquiry. Median age of diagnosis and of death was 37 and 58 years respectively. Results: 37 expert panels concluded that 71%(195/276) were asthma deaths and identified major potential avoidable factors in 67%(130); no record of personal asthma action plans (PAAPs) in 77%(151) of patients.
45%(87) died from asthma before medical assistance was sought or provided. 80%(8/10) of children and 72%(13/18) of young people, died before reaching a hospital.
The panels concluded that there was a failure to recognize and act on high-risk features of asthma attack and death, including excess prescription of reliever inhalers and low prescription of preventer inhalers. 10%(19) died within 28 days of hospital treatment for asthma attacks. 68%(13) of these had inadequate provision for discharge and follow-up. At least 21%(40) of those who died attended Emergency Departments at least once for asthma in the previous year.
58% of those who died were diagnosed as mild or moderately severe asthma. There was room for improvement/care was less than satisfactory in 83% (153/184) of cases.
The 19 NRAD recommendations included: Assess asthma control and take appropriate action, PAAPs for all asthmatics, electronic prescribing alerts and research to determine whether late onset asthma is a risk factor for asthma death.
- © 2014 ERS