National Review of Asthma Deaths (NRAD) & Asthma prescribing – implications for the inhalation community

Mark L Levy

The National Review of Asthma Deaths (NRAD), investigated deaths throughout the United Kingdom in the 12 months from February 2012. This was a confidential enquiry, conducted under Section 251 of the United Kingdom NHS Act 2006, which enabled access to the deceased’s medical records without consent from relatives. 276 cases of all ages, classified under the WHO ICD-10 system as asthma deaths, were investigated in detail by health professionals from primary, secondary and tertiary care. 195/276 (71%) were classified by the enquiry panels as asthma deaths, and as in previous studies, major potentially preventable factors were identified in over 60% of cases. These included failure to perform adequate assessments, such as checking patient’s inhaler technique. A surprise finding was that many of those who died were issued excess prescriptions for short acting beta-2-bronchodilators (SABAs), insufficient prescriptions of inhaled corticosteroids and unopposed long acting bronchodilators (LABAs).
Nearly half of those who died, failed to call for or get treatment in their final attack. This may have been explained by the fact that only 23% of those who died had evidence of having been provided with a self management plan detailing their medication, the rationale for using it, how to recognise risk and when to seek medical assistance. There was a failure to identify risk factors, to implement national guidelines in the management of chronic and acute asthma attacks. Sadly, 18 months after the report, there has been little official action taken by the UK Department of Health who commissioned this study.

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