End asthma attacks- Post attack Review

There have been at least  4 asthma deaths in children and young people in London recently. Asthma attendances at the ED and Urgent Care Centres are increasing and there is considerable variation in hospital admissions throughout the United Kingdom. Furthermore the UK has the highest number of childhood asthma deaths in Europe and third highest overall in the high income countries world wide. These stats are shocking despite the fact that the UK has Nationally produced guidelines (SIGN/BTS and NICE) and free access to medication for children.

While there are local pockets of evidence based care for asthma there has been no clear national directive to implement the NRAD recommendations.

It seems that little has changed nationally  in asthma management in the ten years following the National Review of Asthma Deaths. What on earth is going on??  In essence, we don’t seem to have learnt any lessons from past research by implementing change in practice in managing asthma. This was so clearly illustrated in the tragic cases of Michael Uriely, who died from asthma at the age of 9 years and Sophie Holman who died at age 10   and also Kalila Griffiths  who died age 24. The coroner’s regulation 28 statement (on a potentially preventable death) is published on the Chief Coroners website at https://www.judiciary.gov.uk/publications/michael-uriely/ .

In my view, the UK asthma guidelines while very detailed, are not user friendly and very out of date. While it great for academics to read about specific research findings, jobbing, busy GPs and nurses need very clear simple advice. In particular related to post attack reviews.

An asthma attack is a signal that something serious has gone wrong – an urgent review to identify modifiable risk factors and optimise care is needed.

The post attack review has two aims.

i) To determine whether the attack is over

ii) to identify modifiable risk factors and optimise care to fix these. A list of modifiable risk factors is available in Box 2-2 in the GINA Strategy document at https://ginasthma.org/reports/   and are also discussed in my Asthma Spotlight Podcast: see  youtube https://t.co/mYvVZ4qGf7, Asthmaspotlight, https://apple.co/3Eo2OjR

Please also see my lecture on this topic at: https://www.pcrs-uk.org/resource/demand-webinar-keeping-people-asthma-safe


3 thoughts on “End asthma attacks- Post attack Review

Leave a Reply