I was fortunate to have been on the steering committee for the National Review of Asthma Deaths (NRAD). It is an extremely important document, published in 2014, highlighting the number of preventable deaths from asthma and making clear recommendations to address this. It is unacceptable that four years after NRAD publication 18 of the 19 recommendations have not been implemented nationally, despite at least two high profile inquests resulting in Regulation 28 statements based on the coroners’ conclusions these were preventable asthma deaths. Asthma deaths are rising and shockingly the UK has the highest number of preventable childhood asthma deaths in Europe and the third highest in the world. Every hospitalisation, every exacerbation of asthma, and every time a reliever inhaler is issued is an opportunity to prevent future harm but this is not currently happening.
There are potentially a number of reasons why this is the case. Unfortunately, new NICE asthma guidelines have complicated treatment options and, in my view, the monetary expense and professional time to develop these guidelines could have been spent commissioning a national directive to implement existing guidelines and NRAD. On treatment, NICE correctly defines asthma as an inflammatory condition and yet, recommends, short-acting bronchodilator (SABA) reliever inhalers should be prescribed for newly diagnosed people with asthma – illogically not managing the chronic inflammation within the airways.
To me a clear message that we need to instil in all HCPs and patients – for all but a few people: asthma = inflammation = Inhaled corticosteroid (ICS). Having two national sets of guidelines, NICE and BTS/SIGN does not provide a clear treatment steer. Common sense must prevail so that in the future we will have one clear, practical evidence-based guideline for the management of asthma in the UK. Although it is essential to ensure correct diagnosis before treating people, the NICE diagnostic guideline, may also have directed interest away from NRAD recommendations. NICE claimed that up to one-third of asthma patients have been mislabelled and GPs were accused of trivialising the disease. Such news headline messages can be detrimental in improving the approach to patient care through the NHS. The overall situation is confusing to primary care clinicians.