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Practice nurses need better training to prevent asthma deaths


A “step-change” is needed in asthma treatment, with better training for practice nurses and more specialist nurse posts, experts have said in the wake of the largest ever national study of deaths from the condition.

The National Review of Asthma Deaths, published on 6 May – World Asthma Day – by the Royal College of Physicians, called for an “end to complacency” around asthma care to avoid unnecessary deaths from the condition.

“It’s time to end our complacency about asthma, which can, and does, kill”

Kevin Stewart

The review examined 195 cases where patients were recorded as dying from asthma. It concluded education improvements were needed so both patients and clinicians were better at recognising the signs of asthma deterioration and at acting quickly when faced with a potentially fatal exacerbation.

Every hospital and GP practice should have a named clinician for asthma services, and all patients should be given a personal asthma action plan, it added.

The review found 45% of the patients did not have any clinical help during their final asthma attack. In addition, it judged the standard of care received in a quarter of those who died as less than satisfactory and said there was “room for improvement” in care received by 83%.

Triggers for asthma attacks had not been documented in more than half of cases, and there was also widespread under-use of preventer inhalers and excessive over-reliance on reliever inhalers.

“This review should serve as a wakeup call for everyone involved in providing care to patients with asthma”

Monica Fletcher

Meanwhile, 10% died within one month of discharge following treatment for asthma and at least 21% had attended an emergency department once or more in the previous year.

Dr Kevin Stewart, clinical director of the RCP’s Clinical Effectiveness and Evaluation Unit, said: “It’s time to end our complacency about asthma, which can, and does, kill. 

“We haven’t paid enough attention to the importance of good routine asthma care by clinicians with the right training and experience and the part patients themselves play in this.”

The Association of Respiratory Nurse Specialists and Royal College of Nursing called for a “step change” in the way asthma was treated and understood.

Rebecca Sherrington

Rebecca Sherrington

In particular, they called for investment in education for non-specialists such as practice nurses, and the appointment of a nurse lead for asthma in every clinical commissioning group.

ARNS chair Rebecca Sherrington said: “Not delivering these improvements is simply not an option if we are to prevent more individuals dying needlessly.”

Monica Fletcher, chief executive of the nursing charity Education for Health, added: “The results of this review should serve as a wakeup call for everyone involved in providing care to patients and their families with asthma.”


What do you think of these findings?

Let us know on twitter on Wednesday 7 May at 1pm. Search for #NTtwitchat and use this hashtag in all your tweets to follow the debate.


Readers' comments (4)

  • When I worked in a medical centre as a clinical assistant one the things I noticed as an observer of nursing care (mostly great!) was that when teaching clients about using a spacer, or about regularly using their preventative inhalers there just wasn't enough time taken or understanding that clients needed more time to practice and feedback what they had learned to cement the information. I had been an asthmatic myself and had not used a spacer before and even I, working in that medical environment and understanding the importance of correct use of inhalers, found the teaching of spacer use confusing and hard to remember. So I could imagine that many of our clients who were given a quick demonstration, asked if they understood all the information (who wants to admit they don't?) and sent home, would probably go away and go back to using their ventolin acutely as before. It is all about communication communication communication and having the time to really be able to explain and empower the client to take responsibility for their health, whether they then choose to or not. I decided then that once I was qualified I would make sure I would alway try to give clients the tools they needed to be responsible and not assume that they had understanding without proper feedback. However, in real life practice is not always like that but with good referrals and by remembering that clients need good education and communication things can change. More education for practice nurses would be fantastic, but you still have to persuade the practices to send the nurses to the training...

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  • Yes, time is needed but with the ever growing pressures on practice nurses from all specialities where do we find it. Also, I am a practice nurse and I regularly see and review asthmatic patients. I spend time teaching them about their condition, how to recognise and manage signs of exacerbation and inhaler use. Time after time the same patients return having ignored all my advice and continuing to use the reliever inhaler only as 'its the only one that works for me'. Believe me changing this behaviour is very challenging and ongoing. As with any disease there will always be a group of patients who do not engage with us. Any ideas anyone?

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  • Ellen Watters

    Having worked in respiratory medicine for over 4 years, I witnessed on a regular basis how quickly asthmatics can 'go off'. It's pretty scary.

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  • Education is key to changing outcomes & behaviours, if patients attend Asthma reviews. So how to reach those who DNA? a new approach in needed, which is why we set up our company to tackle this issue in a different & training in other enviroments.

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