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Unsafe prescribing puts the lives of thousands of people with asthma at risk

An Asthma UK report published today urges healthcare professionals to routinely review their asthma patients' prescriptions

Healthcare professionals should routinely review their patients’ use of asthma inhalers as the lives of thousands of people with the condition are put at risk each year from unsafe prescribing, a report warns.

Asthma UK analysed the data of 94,955 asthma patients between 2010 and 2013 from more than 500 GP practices across the UK.

A total of 402 people were found to have been prescribed long-acting reliever medicines – usually green inhalers that are taken to help with shortness of breath – without steroid inhalers (usually brown). It is dangerous to use a long-acting reliever inhaler without a steroid preventer inhaler because long-acting reliever medicines only help keep airways open and do not treat the underlying inflammation.

If the figures are applied across the UK population – there are 1.1 million children and 4.3 million adults with asthma in the UK – around 22,840 people with asthma, including 1,903 children, may have been prescribed reliever medicine on its own putting them at higher risk of death.

The report says there is no reason why asthma patients should be prescribed long-acting reliever medicines without inhaled steroids, adding that systems should be in place to prevent this unsafe practice.

It states that any patient found to be taking reliever medicines alone should be contacted immediately for an asthma medication review at their GP practice.

The charity conducted the research in response to a report published last year by the National Review of Asthma Deaths, which investigated the deaths of 195 people who died from asthma between 2012 and 2013. It found alarming safety concerns, and in particular prescribing errors.

The aim of the analysis was to ascertain how often the prescribing errors identified in the national review occur in the routine care of the general asthma population.

Asthma UK chief executive Kay Boycott said: ‘It is simply unacceptable that the lives of people with asthma are being put at risk because of unsafe prescribing. The UK has some of the highest mortality rates for asthma in Western Europe and the levels of unsafe prescribing identified in our report must be stopped. It is crucial that healthcare professionals review their systems and urgently recall patients who have been prescribed long-acting reliever inhalers on their own without a steroid preventer, or not as a combination inhaler.

‘NHS bodies must ensure systems are in place to stop unsafe asthma prescribing from happening and implement all the recommendations from the National Review of Asthma Deaths to improve patient safety and end complacency in asthma care.’

Reliever inhalers are used to relieve asthma symptoms in the short term but do nothing to stop the next attack from happening in the long term.

Asthma UK's report also found that a total of 5,032 people had been prescribed more than 12 reliever inhalers over a 12-month period and 1,965 people received them without being reviewed, representing nearly 40%. The number of excessive reliever inhalers prescribed ranged from 13 up to 80 per person in 12 months.

Given that six is a clear warning sign of poor asthma control, the prescribed number suggests patients are receiving nearly 13 times more medicine that they need, the report says.

RCN general secretary Peter Carter said the figures are ‘worrying’.

‘Because asthma is relatively common, many people overlook the seriousness of the condition and can be unaware of available effective preventive treatments,' he said.

‘Nurses and pharmacists teach inhaler technique and should receive training in it to ensure that people are supported to take their medications effectively.’

Association of Respiratory Nurse Specialists chair Matthew Hodson said the report highlights respiratory nurses and staff in primary care need appropriate training as patients are not always receiving adequate information about their medication and how it must be taken.

‘Correct training is crucial and should encompass the correct diagnosis, the understanding of asthma guidelines in practice and the best evidence for long-term treatment.’

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