The national review of asthma deaths: what did we learn and what needs to change?

KEY POINTS: The 2014 UK National Review of Asthma Deaths identified potentially preventable factors in two-thirds of the medical records of cases scrutinised; 45% of people who died from asthma did not call for or receive medical assistance in their final fatal attack. Overall asthma management, acute and chronic, in primary and secondary care was judged to be good in less than one-fifth of those who died. There was a failure by doctors and nurses to identify and act on risk factors for asthma attacks and asthma death. The rationale for diagnosing asthma was not evident in a considerable number of cases, and there were inaccuracies related to the completion of medical certificates of the cause of death in over half of the cases considered for the UK National Review of Asthma Deaths. EDUCATIONAL AIMS: To increase awareness of some of the findings of the recent UK National Review of Asthma Deaths and previous similar studies. To emphasise the need for accurate diagnosis of asthma, and of the requirements for completion of medical certificates of the cause of death. To consider areas for improving asthma care and prevention of attacks and avoidable deaths. SUMMARY: Despite the development and publication of evidence-based asthma guidelines nearly three decades ago, potentially preventable factors are repeatedly identified in studies of the care provided for patients who die from asthma. The UK National Review of Asthma Deaths (NRAD), a confidential enquiry, was no exception: major preventable factors were identified in two-thirds of asthma deaths. Most of these factors, such as inappropriate prescription and failure to provide patients with personal asthma action plans (PAAPs), could possibly have been prevented had asthma guidelines been implemented. NRAD involved in-depth scrutiny by clinicians of the asthma care for 276 people who were classified with asthma as the underlying cause of death in real-life. A striking finding was that a third of these patients did not actually die from asthma, and many had no recorded rationale for an asthma diagnosis. The apparent complacency with respect to asthma care, highlighted in NRAD, serves as a wake-up call for health professionals, patients and their carers to take asthma more seriously. Based on the NRAD evidence, the report made 19 recommendations for change. The author has selected six areas related to the NRAD findings for discussion and provides suggestions for change in the provision of asthma care. The six areas are: systems for provision and optimisation of asthma care, diagnosis, identifying risk, implementation of guidelines, improved patient education and self-management, and improved quality of completion of medical certificates of the cause of death.