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Patient safety failures in asthma care: research report

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Almost 23,000 people with asthma may have been unsafely prescribed medication for their condition in recent years

A report by Asthma UK, Patient safety failures in asthma care: the scale of unsafe prescribing in the UK, suggests that almost 23,000 people with asthma may have been unsafely prescribed medication for their condition in recent years that puts them at a higher risk of death.

Asthma UK reviewed a sample of GP data from 2010 to 2013 which suggested that almost 21,000 adults and 2,000 children across the UK may have been given long-acting reliever inhalers alone – instead of in combination with the required inhaled steroids.

Asthma UK pointed to a lack of training and education, inadequate systems for identifying and preventing human errors, and a culture that fails to acknowledge the seriousness of asthma as possible reasons for the prescribing errors.

It has urged healthcare professionals to implement recommendations from the National Review of Asthma Deaths, which took place last year to protect people with asthma in the UK from avoidable harm and preventable deaths.

Further reading

 

Frequently asked questions

What is the difference between obstructive and restrictive lung disease?

Part of the process of assessing patients who present with breathlessness, cough or other respiratory symptoms involves undertaking breathing tests to determine how well the lungs are functioning.

This involves measuring the amount of air that can be forcefully exhaled from a full breath into a device called a spirometer. These measurements are compared to values that we would expect for someone of similar height, age and gender to achieve (called predicted values). With a clinical history and examination these measurements help us to judge whether symptoms are the result of an obstructive or restrictive process. The volume exhaled in the first second (Forced Expiratory Volume – FEV1) is expressed as a percentage of the total volume exhaled (Forced Vital Capacity – FVC) or FEV1/FVC ratio and is normally above 70%.

In obstructive lung disease, the airways are narrowed, making it difficult to exhale quickly giving a reduced FEV1/FVC ratio. This may be temporary, such as in acute asthma, when the airways can rapidly constrict in response to a trigger such as pollen, house dust mite or pet dander. This is treated with inhaled bronchodilators and inhaled corticosteroids.

In chronic obstructive disease such as emphysema, long standing damage to the airways causes permanent and irreversible narrowing which does not respond well to inhaled therapy, resulting in long term symptoms of breathlessness, which progress over time. The lungs become enlarged, or hyperinflated, increasing the work of breathing.

In restrictive lung disease, the total volume of the lungs is reduced; this is seen in pulmonary fibrosis, when scarring in the lung tissue causes ‘stiffening’ of the lungs, typically resulting in progressive and marked breathlessness on exertion. The breathing tests show a reduction in both the FEV1 and FVC (‘small’ lungs) but the FEV1/FVC ratio is normal (above 70%) as there is no narrowing in the airways. Restrictive lung volumes are also seen where the chest wall is unable to expand normally as a result of conditions such as obesity, kyphoscoliosis or conditions that result in weak respiratory muscles, such as myasthenia gravis or muscular dystrophy.

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