National Review Of Asthma Deaths Research Articles

Evaluation of the efficacy of asthma information videos ('Moving On Asthma') at improving knowledge in teenage children.

Asthma is a common inflammatory condition that can be life threatening. The National Review of Asthma Deaths (2014) recommended: Parents and children…should be educated about managing asthma. The aim of this study was to assess the efficacy of an educational video on asthma at improving knowledge in adolescent children. A 3-minasthma education video was shown to young people aged 13-15 years in two contrasting schools. Knowledge of asthma was evaluated using a 6-question form completed at 3 timepoints: baseline (pre), immediately after intervention (post), and 1 week later (delayed). A total of 151 data sets from two schools were analysed. Knowledge was significantly improved immediately after watching the video for four out of six questions, indicating that the video was successful in effectively educating the children about asthma. There was no significant change to responses between immediately after watching the video and a week later, suggesting retention of the knowledge gained from viewing the intervention material. The results suggest acquisition and retention of knowledge in young people after watching a video on asthma, providing evidence to support the use of digital, video-assisted, internet-based learning tools such as the 'Moving on Asthma' website as an aid to regular clinics for young people with asthma.

An audit to review high risk asthma patients with over-use of short-acting beta-agonist inhalers

Abstract Introduction The UK National Review of Asthma deaths (NRAD)1 has shown that the over-prescribing of Short Acting Beta Agonist’s (SABA) inhalers is a risk factor for exacerbation and death in asthmatic patients. A quality improvement audit was identified as a priority to review practice performance in line with national guidelines.2,3 Aim The aim was to identify patients on the asthma register who were prescribed 12 or more SABA inhalers within the preceding 12 months and investigate any reasons for overuse. Additionally, patients were highlighted for review to optimise management in line with national recommendations2,3. Methods A search run in a GP practice highlighted high-risk patients on the asthma register prescribed 12 or more SABAs in the preceding 12 months. Audit criteria were defined to assess if 100% of patients had a completed annual asthma review. Patients who were not asthmatics or undergoing investigations for a potential diagnosis of chronic obstructive pulmonary disease (COPD) were excluded. Phase 1 of the audit was notes-based data-collection on recent asthma reviews and reasons for potential overuse. In Phase 2, patients were contacted prioritising those overdue a review. During contact, the Asthma Control Test, checking inhaler technique, discussing any reasons for SABA over-use and patient education on their inhalers were all discussed. Patients requiring treatment optimisation or a follow-up review were highlighted for referral to various members of the multidisciplinary team. This audit did not require ethical approval. Results 42 out of 988 patients with asthma were identified as being issued more than 12 SABA’s in the preceding 12 months. 1 patient was excluded due to having a diagnosis of COPD. Out of the remaining 41 patients, 16 patients had already had an up to date annual asthma review prior to the search. 13 patients were contacted and referred to the pharmacist or asthma nurse for a review. As a result of the audit, a total of 29 patients had an asthma review conducted. 12 patients were unable to be contacted and follow-up remains outstanding. A number of themes were highlighted during the audit such as patients using the incorrect dose or inhaler, lack of understanding on how the inhaler worked, requests for spare inhalers, absence/lack of using an inhaled corticosteroid (ICS) and worsening asthma. Discussion/Conclusion The audit successfully identified reasons for SABA overuse and using the multidisciplinary team to educate patients and optimise medication where needed. Following this audit, the practice has reviewed cohorts of patients that are at high risk of exacerbations and implemented quarterly safety searches to highlight these for review on a regular basis. Two further audits were also identified to improve practice in line with updated national guidance; patients prescribed a SABA alone without an ICS and patients prescribed a Long-acting beta-agonist (LABA) alone without an ICS.

How often do you ask about asthma?

British Journal of Cardiac NursingVol. 16, No. 9 EditorialHow often do you ask about asthma?Aysha MendesAysha MendesCorrespondence to: Aysha Mendes; E-mail Address: [email protected]British Journal of Cardiac Nursing, MA Healthcare Ltd, London, UKSearch for more papers by this authorAysha MendesPublished Online:28 Sep 2021https://doi.org/10.12968/bjca.2021.0114AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Andrianasolo RM, Kesse-Guyot E, Adjibade M et al. Associations between dietary scores with asthma symptoms and asthma control in adults. Eur Respir J. 2018; 52(1):pii:1702572. https://doi.org/https://doi.org/10.1183/13993003.02572-2017 Crossref, Google ScholarAsthma UK. Your child's asthma action plan. 2016a. https://tinyurl.com/yb4f9dda accessed 14 September 2021) Google ScholarAsthma UK. Smoking and second-hand smoke. 2016b. https://tinyurl.com/y7y5mwkk (accessed 17 September 2021) Google ScholarDonnelly L. UK asthma death rates among the worst in Europe. 2018. https://tinyurl.com/y85qznf4 (accessed 14 September 2021) Google ScholarEuropean Lung Foundation. Healthy diet reduces asthma symptoms. 2018. https://tinyurl.com/y83bdkvl (accessed 17 September 2021) Google ScholarHealthy London Partnership. #AskAbout Asthma. 2017. https://tinyurl.com/yasq4kf4 (accessed 14 September 2021) Google ScholarHealthy London Partnership. #AskAboutAsthma – pharmacy – pledge. 2018a. https://tinyurl.com/y7w9pyo9 (accessed 14 September 2021) Google ScholarHealthy London Partnership. Asthma and air pollution: avoid it where you can and stay safe by planning your preventative medication. 2018b. https://www.healthylondon.org/asthma-and-air-pollution-avoid-it-where-you-can-and-stay-safe-by-planning-your-preventative-medication/ (accessed 14 September 2021) Google ScholarHealthy London Partnership. Asthma action plan. 2018c. https://tinyurl.com/y7yyckld (accessed 14 September 2021) Google ScholarHealthy London Partnership. Asthma and air pollution: avoid it where you can and stay safe by planning your preventative medication. 2018d. https://tinyurl.com/y7utq492 (accessed 14 September 2021) Google ScholarLevy ML, Garnett F, Kuku A et al. A review of asthma care in 50 general practices in Bedfordshire, United Kingdom. NPJ Prim Care Respir Med. 2018;28:29. https://doi.org/10.1038/s41533-018-0093-7 Crossref, Google ScholarPhillips H, Miller K. Innovation in cardiac care: a young person's pacemaker. Br J Cardiac Nurs. 2018;13(5):248–249 Link, Google ScholarRoyal College of Physicians. Why asthma still kills: the National Review of Asthma Deaths (NRAD). 2014. https://tinyurl.com/y9ggvoql (accessed 14 September 2021) Google ScholarThomas M, Bruton A. Breathing exercises for asthma. Breathe. 2014;10:312-322. https://doi.org/https://doi.org/10.1183/20734735.008414 Crossref, Google ScholarThomson NC, Chaudhuri R, Livingston E. Asthma and cigarette smoking. Eur Respir J. 2004;24:822-833. https://doi.org/https://doi.org/10.1183/09031936.04.00039004 Crossref, Google Scholar FiguresReferencesRelatedDetails 2 September 2021Volume 16Issue 9ISSN (online): 2052-2207 Metrics History Published online 28 September 2021 Published in print 2 September 2021 Information© MA Healthcare LimitedPDF download

Beating asthma through education

Abstract Asthma is a common, chronic respiratory disease which affects 1 in 11 children within the UK. The National Review of Asthma Deaths (NRAD) highlighted common and avoidable factors contributing to the deaths and made recommendations for care. The team at the Great North Children's Hospital (GNCH) recognized a need for change, which led to the development of a new educational programme. BeatAsthma was co-designed with stakeholders. It comprises over 170 resources available for use in primary, secondary and tertiary care. This article briefly describes our experience and some of the materials available and the early results of this intervention.

Acute asthma exacerbations: tips from the shop floor.

Asthma places a significant burden on acute and non-acute services and is frequently encountered in the emergency department and the medical take. The UK has one of the highest asthma mortality rates in Europe. The National Review of Asthma Deaths has identified multiple factors that have contributed to preventable asthma deaths and solutions to these factors, including a better understanding and implementation of asthma guidelines. The British Thoracic Society and Scottish Intercollegiate Guidelines Network have recently updated their guidance on the management of asthma. This article outlines the guidelines for junior doctors managing patients with acute exacerbations of asthma. It highlights key areas of the initial assessment, establishing severity and initiating and escalating treatment. Furthermore, the discharge process from discharge criteria to promoting patient safety, education and ongoing self-management is discussed. This process, in particular education and personalised asthma action plans, can make a significant difference to the patient's outcomes and day-to-day burden of symptoms.

Asthma in children during the COVID-19 pandemic: lessons from lockdown and future directions for management

Asthma in children during the COVID-19 pandemic: lessons from lockdown and future directions for management

Paediatric asthma care in the UK: fragmented and fatally fallible.

The National Review of Asthma Deaths (NRAD) report entitled Why Asthma Still Kills ,1 published on World Asthma Day in May 2014, concluded that only one of the 28 children and young people (CYP) who died had been adequately managed by health professionals. Of the 19 NRAD recommendations only one has been initiated nationally in the UK, namely setting up a National Asthma Audit, which has yet to report after nearly 5 years. Care for children with asthma in the UK is mainly provided in primary care, and is often limited to the few tasks set out in the Quality and Outcomes Framework (QOF)2 to provide data to qualify for payments. Currently the QOF requires a recorded asthma diagnosis confirmed by measures of airflow reversibility, smoking status, and evidence of an asthma review in the preceding 12 months that includes an assessment of asthma control using the Royal College of Physicians’ three questions (RCP 3 Questions); the latter are not validated and nor are they recommended for children aged <16 years by the UK Asthma Guidelines.3 The aim of the NRAD was to identify potentially preventable factors related to care preceding these tragic (and often preventable) deaths. The confidential inquiry identified a number of key themes associated with potentially preventable asthma deaths, which included: lack of objective evidence for the diagnosis of asthma and certification of death due to asthma; excess prescriptions and overreliance on reliever medication; insufficient prescriptions (and collection) of preventer (controller) medications; lack of provision of education for patients (in the form of personal asthma action plans [PAAPs]); and, importantly, a marked failure by health professionals, patients, and their carers to recognise risk of poor outcome in those who have already had at least one asthma attack. All these factors were previously known from …

New models of care for allergy

New models of care for allergy

Transforming asthma care in schools in Islington: The Asthma Friendly Schools Project UK

Asthma remains the most common chronic disease of childhood, associated with significant morbidity and high rates of school absenteeism. Children spend the equivalent of 190 days a year in school with approximately 3 children with asthma per class of 30. Thus, schools are a key stakeholder in any successful asthma care network. The Asthma Friendly Schools project is ambitious cross-sector initiative, which aims to make schools safer for children with asthma, reducing asthma-related school absence and improving local morbidity and mortality rates. An Asthma Friendly Schools nurse worked collaboratively with participating schools to implement 5 asthma friendly standards. Standards were designed by the project team and placed a focus on getting the basics right; a key recommendation of the National Review of Asthma Deaths. Building partnerships between education and health has allowed The Asthma Friendly Schools Project to implement a comprehensive change to in-school asthma care. The authors propose that this has had a direct effect on school absence rates, indicative of better asthma control.

Insights into frequent asthma exacerbations from a primary care perspective and the implications of UK National Review of Asthma Deaths recommendations

The United Kingdom National Review of Asthma Deaths (NRAD) recommends that patients who require ≥3 courses of oral corticosteroids (OCS) for exacerbations in the past year or those on British Thoracic Society (BTS) Step 4/5 treatment must be referred to a specialist asthma service. The aim of the study was to identify the proportion of asthma patients in primary care that fulfil NRAD criteria for specialist referral and factors associated with frequent exacerbations. A total of 2639 adult asthma patients from 10 primary care practices in Glasgow, UK were retrospectively studied between 2014 and 2015. Frequent exacerbators and short-acting β2-agonist (SABA) over-users were identified if they received ≥2 confirmed OCS courses for asthma and ≥13 SABA inhalers in the past year, respectively. Community dispensing data were used to assess treatment adherence defined as taking ≥75% of prescribed inhaled corticosteroid (ICS) dose. The study population included 185 (7%) frequent exacerbators, 137 (5%) SABA over-users, and 319 (12%) patients on BTS Step 4/5 treatment. Among frequent exacerbators, 41% required BTS Step 4/5 treatment, 46% had suboptimal ICS adherence, 42% had not attended an asthma review in the past year and 42% had no previous input from a specialist asthma service. Older age, female gender, BTS Step 4/5, SABA over-use and co-existing COPD diagnosis increased the risk of frequent exacerbations independently. Fourteen per 100 asthma patients would fulfil the NRAD criteria for specialist referral. Better collaboration between primary and secondary care asthma services is needed to improve chronic asthma care.

A review of asthma care in 50 general practices in Bedfordshire, United Kingdom

The United Kingdom (UK) National Review of Asthma Deaths (NRAD) (2011–2014) identified a number of contributory risk factors which had not previously been recognized by those caring for people with asthma. Only one of the 19 NRAD recommendations has so far been implemented nationally, and that only partially, and as yet systems are not in place to identify patients at risk of attacks and dying from asthma. In 2015/2016 Bedfordshire Clinical Commissioning Group (CCG) in England, UK, initiated a quality asthma audit of people with asthma to identify some of the risk factors identified in the NRAD report with the aim of optimizing patient care. Fifty (89%) of the General Practices caring for 415,152 patients (27,587 diagnosed with asthma (prevalence 7%; range 4–12%)), participated and the results identified a wide variation in process of care and presence of risk factors including: excess short acting reliever and insufficient preventer prescriptions, failure to issue personal asthma action plans, and to perform annual reviews or check inhaler technique. Identification of these patients involved high-intensity input by trained asthma nurses using sophisticated data extraction software. GP computer systems used in primary care currently do not have the functionally, without the need for manual audit, to implement the NRAD recommendations, starting with the identification of patients at risk. Modifications to existing systems within both primary and secondary care are required in order to prevent unnecessary deaths related to asthma. There is a pressing need to move towards a more pro-active model of care.

High health gain patients with asthma: a cross-sectional study analysing national Scottish data sets

Studies have shown that a small proportion of patients have particularly high needs and are responsible for disproportionally high disease burden. Estimates suggest that 2–5% of patients are high users of healthcare for their health gain. Such patients in Scotland are referred to as high health gain (HHG) patients. We wanted to investigate if there were HHG individuals with asthma in Scotland. We analysed data from the Scottish Health Survey (2010–11), and primary and National Health Survey (NHS) secondary healthcare and administrative data sets (2011–12). In all, 1,379,690 (26.0%) and 836,135 (15.8%) people reported to have ever had and currently have symptoms suggestive of asthma, respectively; 369,868 (7.0%) people reported current symptomatic clinician-diagnosed asthma. 310,050 (5.6%) people had clinician-reported-diagnosed asthma; there were 289,120 nurse consultations, 215,610 GP consultations, 9235 accident and emergency visits (0.2% people), 8263 ambulance conveyances (0.2% people), 7744 inpatient episodes (0.1% people), 3600 disability allowance claims (0.1% people), 187 intensive care unit (ICU) episodes and 94 deaths from asthma. From our study a maximum of about 9.4% of asthma patients (n = 29,145), which is 0.5% of the Scottish population, and from the National Review of Asthma Deaths’ estimate (10% hospitalised), a minimum of nine people had severe asthma attacks that needed acute hospital attendance/admission. We found that although a high proportion of the Scottish population had symptoms suggestive of asthma and clinician diagnosed asthma, only a small proportion of asthma patients experienced exacerbations that were severe enough to warrant hospital attendance/admission in any given year. Developing risk prediction models to identify these HHG patients has the potential to both improve health outcomes while substantially reducing healthcare expenditure.

New asthma testing enhances the care of respiratory patients

New asthma testing enhances the care of respiratory patients

Management of children and young people (CYP) with asthma: a clinical audit report

An asthma attack or exacerbation signals treatment failure. Most attacks are preventable and failure to recognize risk of asthma attacks are well recognized as risk factors for future attacks and even death. Of the 19 recommendations made by the United Kingdom National Review of Asthma Deaths (NRAD) (1) only one has been partially implemented—a National Asthma Audit; however, this hasn’t reported yet. The Harrow Clinical Commissioning Group (CCG) in London implemented a clinical asthma audit on 291 children and young people aged under 19 years (CYP) who had been treated for asthma attacks in 2016. This was funded as a Local Incentive Scheme (LIS) aimed at improving quality health care delivery. Two years after the publication of the NRAD report it is surprising that risks for future attacks were not recognized, that few patients were assessed objectively during attacks and only 10% of attacks were followed up within 2 days. However, it is encouraging that CYP hospital admissions following the audit were reduced by 16%, with clear benefit for patients, their families and the local health economy. This audit has provided an example of how clinicians can focus learning on patients who have had asthma attacks and utilize these events as a catalyst for active reflection in particular on modifiable risk factors. Through identification of these risks and active optimization of management, preventable asthma attacks could become ‘never events’.

Persistent variations in national asthma mortality, hospital admissions and prevalence by socioeconomic status and region in England

BackgroundThe UK-wide National Review of Asthma Deaths sought to identify avoidable factors from the high numbers of deaths, but did not examine variation by socioeconomic status (SES) or region.MethodsWe used...

Should oral steroids be routinely supplied to prevent asthmatic relapse?

In 2014, the National review of Asthma Deaths recognised the significant burden of associated morbidity, amongst avoidable factors and recent contact with healthcareprofessionals that commonly occur prior to a fatal asthma exacerbation. It also recognised delayed and undersupply of preventer medications, particularly oral steroids, that are linked to relapsing into a repeat exacerbation. Oral steroids are not without significant systemic side effects and carry their own risks which must be balanced against the risk of relapse. This literature review seeks to establish if oral steroids should be routinely supplied to prevent asthmatic relapse. Exacerbations induced by viruses, allergies and medications are commonly known to contribute towards deterioration and these high risk patients have been found to gain the most benefit from a 7-10 day course of oral steroids. This is recommended as an effective, cheap and safe option with minimal side effects for higher risk patients. Paramedics should consider supplying, or obtaining a supply of oral steroids for high risk asthmatics following an acute exacerbation of asthma when the patient does not require, or refuses, further assessment or observation in an accident and emergency department.

Severe asthma in children.

Most children with asthma have their disease easily controlled if low-dose inhaled corticosteroids (ICSs) are regularly and correctly administered. If a child presents with asthma which is apparently resistant to therapy with high-dose ICS and other controllers, then they have problematic severe asthma. However, in light of the UK National Review of Asthma Deaths, definitions of severe asthma based solely on the levels of prescribed treatment are too narrow. A detailed assessment of all such children should be performed. First, the diagnosis of asthma should be confirmed, then co-morbidities assessed. Next, a nurse-led assessment further characterizes the problem, conventionally categorizing the child as either having difficult asthma or severe therapy-resistant asthma. Here, we reassess in particular the interactions between, and management of, these two categories, highlighting that this dichotomous classification may need reconsideration. We use bronchoscopy and an intramuscular steroid injection to determine if the child has steroid-resistant asthma, using a novel, multidomain approach because the adult definition does not apply to around half the children we see. Finally, we highlight some mechanistic data which have emerged from this protocol such as the absence of T-helper 2 (TH2) cytokines even in eosinophilic severe asthma and the potential role of the innate epithelial cytokine IL-33, novel data on lineage negative innate lymphoid cells, which we can measure in induced sputum, and demonstrating that intraepithelial neutrophils are associated with better, not worse asthma outcomes. Severe paediatric asthma is very different from severe asthma in adults, and approaches must not be uncritically extrapolated from adult disease to children.

Over-use of short-acting inhalers for uncontrolled asthma

Why asthma still kills is the National Review of Asthma Deaths' first national investigation of asthma deaths in the UK and the largest study worldwide to date (Royal College of Physicians (RCP), 2015). The primary aim was to understand the circumstances surrounding asthma deaths to identify avoidable factors and make recommendations to improve care and reduce the number of deaths. Some of the recommendations involve prescribing and medicines use. One of these specifically states, ‘All asthma patients who have been prescribed more than 12 short-acting reliever inhalers in the previous 12 months should be invited for urgent review of their asthma control, with the aim of improving their asthma through education and change of treatment, if required’ (RCP, 2015). The reason for this is that over-use of short-acting relievers can be an indication of uncontrolled asthma. An additional concern due to over-use can be explained by the pharmacology of short-acting relievers. These medicines, such as salbutamol and terbutaline, are beta-2 receptor agonists, and their over-use can lead to the ‘down-regulation’ of receptors, which can result in an insufficient therapeutic effect in an emergency situation (Joint Formulary Committee, 2016). Furthermore, the over-use of medicines can lead to side effects (e.g. palpitations or anxiety), and is a waste of NHS resources.

NICE food allergy and anaphylaxis quality standards: a review of the 2016 quality standards.

The National Institute for Health and Care Excellence (NICE) has in the last 5 years published guidance on several aspects of clinical allergy. In March 2016 they published quality standards on food allergy (QS 118)1 and anaphylaxis (QS 119).2 Despite the recent increase in allergy guidance, not only from NICE but also in the form of a Department of Health Commissioned Pathway Project with the Royal College of Paediatrics and Child Health (RCPCH),3 and several NICE-accredited guidelines from the British Society for Allergy and Clinical Immunology (BSACI), inconsistencies remain in the management of food allergy and anaphylaxis. The National Review of Asthma Deaths highlights that some deaths may have been prevented had there been better management of those with asthma and allergies. Recognition that in uncontrolled asthma, allergic triggers such as food allergy should be considered and also acknowledging that having asthma increases the risk of life-threatening reactions in, for example, those with food allergies, may have prevented some of the deaths.4 It is hoped that these quality standards, accompanied by their performance measures, may drive a further awareness of ideal care of those with suspected food allergy and/or anaphylaxis. The quality standards are divided into six statements for food allergy and four for anaphylaxis. They are based on the corresponding NICE guidelines. ### Quality statement 1: history Identifying the possibility of food allergy comes from taking what NICE terms an allergy-focused clinical history. …

Asthma in children

Asthma affects 1 100 000 children in the UK and is thus the most common long-term condition of childhood. The prevalence of childhood asthma symptoms in the UK is among the highest worldwide and this contributes to the estimated £1 billion annual cost of asthma care to the NHS. Children still die from asthma despite advances in its management, and mortality rates have changed very little over the past 20 years. The recent national review of asthma deaths provided a stark reminder of ‘why asthma still kills’ and made key recommendations for children with asthma. However, evidence-based recommendations are still poorly implemented. This article seeks to enthuse the next generation of GPs to prioritise the improvement of asthma care in children.