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‘Simple steps’ to reduce hospital asthma deaths

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A national care check list has been launched today for NHS hospitals discharging asthma patients who have recently received treatment for an acute asthma attack.

According to those behind the care bundle, successful implementation of just five simple steps by hospital staff, could reduce future life-threatening exacerbations and hospital admissions.

“If this ‘care bundle’ is widely adopted across the NHS it could really help to reduce illness from asthma”

Lisa Davies

The British Thoracic Society and Asthma UK, who jointly produced the initiative, said discharge was a “golden window of opportunity” to review a patient’s current asthma treatment and care, and promote effective future asthma management.

The initiative was triggered by the recent National Review of Asthma Deaths, which found 10% of asthma deaths happened within just one month of previous discharge from hospital.

Recent audits conducted by the British Thoracic Society probing how well NHS hospitals manage children hospitalised for their asthma, concluded discharge was poor, with only 53% of patients given a written asthma plan, and even fewer having inhaler technique checked.

The “care bundle” concept has already been used successfully to improve the care and treatment of chronic lung disease patients, the organisations noted.

This asthma initiative is targeted at hospital-based health professionals and should be used when asthma patients have passed the normal criteria for being discharged from hospital.

The steps can be taken for all adults and children over the age of two years – although children under five may not always be suitable and need special consideration.

Asthma UK

Kay Boycott

Kay Boycott

Dr Lisa Davies, a consultant respiratory physician at University Hospital Aintree NHS Foundation Trust and chair of the British Thoracic Society’s executive committee, said: “It is a tragedy that so many people die from asthma each year in UK. It is a treatable disease and we must do much better to tackle it across the NHS.

“I sincerely believe if this ‘care bundle’ is widely adopted across the NHS it could really help to reduce illness from asthma and save lives,” she said.

Asthma UK chief executive Kay Boycott added: “These simple steps, if taken by hospital staff, could make the difference between life and death to people with asthma.”

The five key actions are these:

  1. Assess inhaler technique – All patients (or family members administering medicines) should have their inhaler technique assessed prior to discharge. This is a critical first step as evidence shows that using an inhaler correctly can radically improve the targeted delivery of treatment to the airways. Good technique is associated with reduced asthma attacks and hospital admissions.
  2. Review medication – All patients should have their medications assessed – both the type of drug and its dose. The importance of taking the right treatment as prescribed should be reinforced with patients and family members. This step is vital as evidence shows that patients who do not take their ‘preventer’ asthma medication as prescribed can see a deterioration in their symptoms and a reduction in control over their asthma.
  3. Provide a written asthma action plan – A written asthma plan should be provided to all patients and their families on how to manage their treatment. There is strong evidence that the provision of a written plan, in addition to verbal advice, is linked to greater patient understanding of asthma and how to manage it. This can reduce the risk of further attacks and hospital admissions.
  4. Consider factors that might trigger or worsen asthma – Factors that trigger or worsen a patient’s asthma, especially at home or in the workplace, should be considered on discharge. These include exposure to tobacco smoke and pets at home and wider issues – such as a patient’s psycho-social instability due to, for example, mental illness. Explicit attention should be paid to potential triggers in the workplace – which could include exposure to chemicals or other factors. If triggers are identified, they require follow up and should be included in the patient’s action plan.
  5. Deliver timely follow up arrangements in the community – A follow-up appointment at the patient’s GP surgery (or other primary care setting) should be arranged within two working days. An appointment with a hospital specialist should be arranged within a month - or two weeks if the patient’s asthma shows clinical indications of needing more urgent review.
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