It’s more than 10 years since the publication of the National Review of Asthma Deaths, which revealed that most deaths from asthma in the UK were preventable.1 In the years since, many of the problems identified in asthma care have persisted, and the annual death toll from asthma has continued to rise.
One of the key risk factors for deaths from asthma is the overuse of reliever inhalers and the underuse of preventer inhalers. When undertaking asthma reviews it’s common to hear patients say that the short acting β2 agonist (SABA) reliever inhaler feels effective, because of its immediate effects—but this in turn can lead to poor compliance with preventer inhalers and an overall worsening of a patient’s asthma.
The National Institute for Health and Care Excellence recently released new guidance that seeks to finally put an end to the overuse of SABAs.2 Clinicians are encouraged to start combination inhalers early on and to use maintenance and reliever treatment regimens rather than creating a counterproductive dependence on SABAs. This could be the watershed moment we’ve all been waiting for in asthma care, but it needs to be accompanied by proactive plans for change and investment to better integrate asthma care and upskill primary care teams in asthma management.
The initial challenge will be to create the time and capacity to ensure that management plans are updated for people with asthma, in line with new guidance. This will require proactive review of patients, especially those who are overusing SABAs. We also need to make sure that clinical staff with delegated responsibility for conducting asthma reviews are confident in assessing asthma control—and are aware that overuse of SABAs is itself a sign of poor control.
It’s important to acknowledge that asthma expertise isn’t available in all practices, and competencies in asthma management can be variable. Research by Asthma + Lung UK showed that seven in 10 people weren’t receiving basic aspects of asthma care.3 As we’ve done for other long term conditions, we have an opportunity to train identified clinicians so that they can offer this expertise at the level of a primary care network or neighbourhood, with easy access to specialist advice in this setting, so that patients with poor asthma control aren’t just kept on the same regimen but go on to have their treatment optimised.
In recent years we’ve finally seen improved access to objective diagnostic tests for asthma. But with the introduction of this new NICE guidance, and the formation of neighbourhood teams, we have a golden opportunity to tangibly improve asthma care so that the next decade doesn’t tell the story of thousands more preventable deaths.4
