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End 'complacency' in asthma treatment, warns medical college

Clinical Inadequate support of asthma patients could have “fatal consequences”, finds report by the Royal College of Physicians

The Royal College of Physicians (RCP) has called for an end to "complacency" around asthma care, after finding a high proportion of unnecessary deaths caused by the condition.

The RCP reviewed 195 people who died from asthma between 2012 and 2013 and found that more than half were only being treated for mild or moderate asthma, which suggested healthcare professionals had not realised the severity of their condition, it said.

Only 23 per cent had been provided with a written personal asthma plan, despite the fact that these should be given to every asthma patient, the RCP said in a reporton asthma deaths published to coincide with World Asthma Day on Tuesday (May 6).

The findings must lead to a "shake-up, more training and monitoring, and an end to the complacency that has arisen regarding this common condition", it said.

Many asthmatics were not "adequately supported" and should be offered MURs and individual asthma plans to reduce the risk of fatal attacks, say pharmacy bodies

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In its report, the RCP found that 39 per cent of the 189 asthmatic patients who were on short-acting reliever inhalers at the time of death had been prescribed more than 12 reliever inhalers in the previous year. These patients were likely to have poorly controlled asthma and should have been invited for an urgent review, the RCP said.

Only 43 per cent of patients were under specialist supervision in the 12 months before their death and more than a fifth of the patients had attended a hospital emergency department at least once in the year before their death, the RCP stressed.

Pharmacists should assess a patient's inhaler technique each time they dispensed a new device, the RCP said in its only reference to the profession in the report.

Pharmacy bodies responded to the RCP's findings by calling for pharmacists to target discharged asthma patients for MURs in order to reduce unnecessary deaths from respiratory attacks.

PSNC NHS services head Alastair Buxton said the report confirmed that inadequate support of asthma patients could have "fatal consequences" and advised pharmacists to look out for prescriptions, which suggested an asthmatic, may be struggling.

Commissioners and the NHS needed to "build on" the MUR service by offering asthmatics an annual review at a pharmacy, Mr Buxton said. Pharmacists also needed the co-operation of hospital colleagues to identify discharged patients who could benefit from a review, he added.

The Royal Pharmaceutical Society echoed the calls for pharmacists to use MURs to identify avoidable risk factors in asthmatics and improve their inhaler technique.

"Improvements are needed so both patients and healthcare professionals are better at recognising the signs of deterioration in asthma and better at acting quickly when faced with a potentially fatal asthma attack," said consultant respiratory pharmacist Anna Murphy in an RPS statement.

Pharmacists should also offer smoking cessation services to asthmatics "at every opportunity", she added.

Do reports such as these lead to real changes in the way health professionals treat patients or does the government need to build change (and fund) into national contracts?
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Kevin Western, Community pharmacist

How does Dr Livingstone feel about "never recommending a patient has an MUR " now? or are all his asthma patients perfectly medicated, compliant and controlled? I have never come across an asthma patient who has been asked to see their Pharmacist by a GP for advice on their medication yet. There was loads of publicity about this over 2 days but AFAIK no mention of Pharmacy. Where were all the talking heads who love publicity? It is easy for them to tell us we should "do more" but a bit harder work getting media interest and changing GP opinion for them obviously.

N O, Pharmaceutical Adviser

Well said Kevin.

Elsewhere on PSNC's website ...... Alastair Buxton, PSNC Head of NHS Services, said: community pharmacists should identify people with asthma whose medication records suggest they may need more help so they can be offered an MUR.

Which means, every time a condition comes in news (last time it was diabetes/ COPD/ Warfarin deaths etc.) the MURs for some reason come in headlines. The problem is with only 400 MURs in a year, how many such conditions can be accommodated by a Pharmacy catering to a large patient base? I am talking about pharmacies with a minimum of 200 patients in each of these categories.

Why not increase the number of overall MURs or atleast start a new service for each of these critical conditions identified for a period of time in a year.

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