More than a million people in the UK with asthma who are at the highest risk of having a potentially fatal asthma attack have not had a face-to-face annual review with their GP or asthma nurse during the pandemic, according to new figures released today by Asthma UK.
The charity is concerned that people who are experiencing uncontrolled symptoms such as using a reliever inhaler three times a week or more, or waking in the night feeling breathless, with a cough, tight chest or wheezing are missing out on getting the level of asthma care they need that could prevent them having a life-threatening asthma attack.
Asthma UK’s new report Asthma Care in a Crisis, released today on World Asthma Day [Wednesday 5 May] has revealed that of those most at risk of an asthma attack:
- Over a quarter (28%) have not had their annual asthma review where medication is assessed
- One in five (21%) have not had their inhaler technique checked. Using an inhaler in the right way can means the full dose of medicine can get into your lungs where it is needed, keeping asthma attacks at bay
- Nearly half (47%) have not had a written asthma action plan which includes information on which medicines you need to take every day to prevent an asthma attack and what to do if your asthma is getting worse.
- Overall, asthma care levels are stagnating due to the backlog of care created by the pandemic, with an estimated 3.5 million people with asthma not receiving all elements of basic asthma care.
- Basic asthma care consists of an annual review, inhaler technique check and written asthma action plan and it should be provided by GP surgeries, according to National Institute for Health and Care Excellence (NICE) best practice guidelines.
Asthma UK is calling for GPs to urgently prioritise asthma reviews for people with uncontrolled symptoms, who are most at risk of having an asthma attack and conduct them face-to-face (for example where there is a clinical need).
Since March 2020, GP practices have had to make vast changes to the way they deliver routine care to protect staff and patients across the healthcare system from coronavirus including the shift to remote care via phone or video. Whilst this may be appropriate for some people with asthma, there are cases when it is clinically necessary to be seen face-to-face.
For example, it is easier for GPs to spot if people are struggling with their asthma if they can check their lung function with a peak flow or spirometry tests and face-to-face appointments mean GPs can ensure people with asthma are using their inhaler properly and getting the medicine they need. This is vital as nearly half of people with asthma are not using their inhaler properly, which means that the full dose of the medicine can’t get into their lungs.
Asthma UK’s latest figures also show that three quarters of people (77%) with asthma who had an annual review would prefer to have it done face-to-face and this was even higher for those with uncontrolled asthma (80%).
The charity is urging the NHS in all nations to put a plan in place to ensure basic asthma care is made available to everyone and the patients at highest risk are seen face-to- face. This should include clear instructions to healthcare professionals on how to prioritise people to see in person, implement guidance on delivering lung function tests safely and provide reassurance for people with asthma that they can visit a GP surgery safely. It should also provide clear guidelines on how to best manage care remotely, to ensure that there are no short-cuts that impact the quality or safety of care.
It is also vital for people with asthma to take up face-to-face or remote appointments when offered so they have the best chance of managing their asthma well and avoiding an asthma attack.
Daniel Taylor, 27, is a gardener from Manchester and went to A&E last October after having a major asthma attack last October where he received treatment. He later had a GP appointment but was only able to get one over the phone. He said:
“My asthma took a turn for the worst when I started waking up at night with a tight chest, feeling wheezy and breathless. I managed symptoms at home with my reliever inhaler, but two days later I had an asthma attack. I was coughing uncontrollably and could barely talk. It was terrifying. My wife drove me to A&E where I was put on equipment to help me breathe and given steroid tablets to help calm down the inflammation in my airways.
“Within two days I spoke to my GP and asthma nurse over the phone. We talked through what had happened and what medication I was on and was prescribed a different, stronger inhaler and sent a video on how to use it. I was hoping to be offered the option of a face-to-face appointment especially because I had just received emergency treatment in hospital, but I wasn’t given the choice.
“Being seen face-to-face would have given me the reassurance that I am OK and that I am using my new inhaler correctly, something which I’m not confident in, especially because it’s been over a year since I’ve had this checked. I think it’s so important that people with asthma are made to feel like they have a choice in how they receive care because phone and video appointments don’t work always work for everyone.”
Dr Andy Whittamore, Clinical Lead at Asthma UK and the British Lung Foundation and a practising GP said:
“It is deeply concerning that so many people including some of the most at risk of an asthma attack are not receiving any basic care which could keep them well and out of hospital. Everyone working in the NHS is trying their hardest in these unprecedented circumstances but it is still vital that everyone with asthma gets the care and support they need to avoid a potentially life-threatening asthma attack.
“GPs need to balance clinical need and what patients want. People experiencing uncontrolled symptoms must be prioritised for an assessment with their GP surgery as they might benefit from a more thorough assessment which may require a face-to-face appointment.
“This World Asthma Day I want to urge anyone experiencing uncontrolled symptoms, such as if you are using your reliever inhaler three times a week or more, to seek help from your GP surgery because delaying or avoiding care could be putting your life at risk. You can get more advice at asthma.org.uk.”
Alison Cook, Director of External Affairs at Asthma UK and the Chair of the Taskforce for Lung Health, a collaboration of over 30 different charities, organisations and patients working to improve lung health, said:
“The fact that so many people living with asthma are still not receiving the support and care they need is unacceptable.
“At a time when we are more conscious of our lungs than ever before, it is particularly troubling to see that in the past year, as many as 450,000 people living with uncontrolled asthma have not been informed about how to use their new inhalers properly, leaving them at risk of life-threatening asthma attacks. An inhaler technique check is basic care and neglecting this type of care puts people at risk.
“Although remote care can be helpful for many people in supporting them with their asthma, for those with uncontrolled symptoms, it is vital that access to face to face care is maintained”.
People aged 18-29 have the lowest basic care rates with just 29% receiving all elements of basic asthma care. Across regions in England, the North-West ranked the lowest, with 32% able to access the basic asthma care they need. Wales has the worst levels of basic care in the UK with just 28% receiving it.
Latest annual asthma deaths data shows, 1,420 people died from an asthma attack in 2019 and over 75,000 were admitted to hospital for emergency treatment.
Asthma UK wants to encourage anyone worried about their asthma to access its website at www.asthma.org.uk where they can access downloadable written asthma action plans, comprehensive health advice to support asthma management, and tips on how to make the most of your GP appointment if you do need to have it remotely.
Notes to Editors:
For more information or for interview requests, please contact the press team on 0207 786 4949 or firstname.lastname@example.org.
Asthma UK and the British Lung Foundation merged on the 1 January 2020.
Asthma UK’s mission is to stop asthma attacks and, ultimately, cure asthma. We do this by funding world leading research, campaigning for improved care and supporting people to reduce their risk of a potentially life-threatening asthma attack. We are entirely funded by voluntary donations. For further information, please visit: asthma.org.uk.
The British Lung Foundation offers hope, help and a voice to the 1 in 5 people in the UK affected by lung disease. We provide support and information to improve the everyday lives of people with lung disease. We are also campaigning for better diagnosis, treatment and prevention for now and the future. For further information, please visit blf.org.uk.
Last year, the charity’s helpline has helped more than 30,000 people with asthma with advice, support and information during the pandemic and more than 7 million people have accessed its health advice via the website.
Asthma UK conducted the eighth edition of the Annual Asthma Survey in summer 2020 and received over 12,000 responses.
 23.75% of survey respondents had uncontrolled asthma and either did not have an annual asthma review, or had it conducted remotely. 23.75% of 5.4 million people with asthma in the UK is 1.28 million people.
 11.53% of survey respondents had uncontrolled asthma and did not have an annual asthma review conducted. 11.53% of 5.4 million people with asthma is 623,000 people.
 8.34% of respondents had uncontrolled asthma and did not have an inhaler technique check. 8.34% of 5.4 million people with asthma is 450,000 people.
 18.76% of respondents had uncontrolled asthma and did not have a written asthma action plan. 18.76% of 5.4 million people with asthma is 1.01million people.
 65.3% of people with asthma did not receive basic asthma care. 65.3% of 5.4 million people with asthma.
 For all survey respondents who had an annual asthma review, 76.66% told us they would prefer to have a face-to-face annual review. For those with uncontrolled asthma, this was 80.1%
 28.6% of survey respondents received basic asthma care, the lowest of all age groups.
 32% of survey respondents received basic asthma care in the North West – the lowest in any region in England.
 All English regions have higher levels of basic asthma care than Wales (27.8%) and Scotland (30.6%).
 Mortality data via Office for National Statistics (England and Wales), National Records of Scotland and the Northern Ireland Statistics and Research Agency (NISRA). Emergency admissions data via bespoke requests from NHS Digital (England), NHS Wales, ISD Scotland and the Department of Health (Northern Ireland).