Tuesday 12 February 2019
Tens of thousands of Brits who had emergency treatment for an asthma attack failed to receive the follow-up care that could save their life, according to new estimates by Asthma UK.*
The charity’s report The reality of asthma care in the UK: Annual Asthma Survey 2018 included a survey of more than 10,000 people with asthma, and found that a quarter (25%) needed emergency care following a potentially life-threatening asthma attack.
But of these, nearly two thirds (64%) said they did not receive a follow-up appointment with their GP or practice nurse within two working days. This is recommended by experts and guidelines including the National Institute for Health and Care Excellence (NICE) and in the National Review of Asthma Deaths (NRAD).**
Prompt follow-up care is essential to get symptoms fully under control, prevent future asthma attacks and reduce the likelihood of further hospital admissions. One in six people who have emergency treatment for their asthma have another asthma attack in the following two weeks,*** while last year, nearly 5,000 people in England were readmitted to hospital within 30 days of being admitted for an asthma attack.****
Asthma UK says that after someone has been treated at hospital, ideally their GP should be notified and a follow-up appointment arranged. But issues with data-sharing across the NHS means that this isn’t happening, and the burden is falling on patients to book an appointment.
Of the people with asthma who didn’t get follow-up care, two-thirds (65%) said they didn’t know they should get it. Nearly a quarter (22%) said they couldn’t get an appointment with their GP because there was no availability.*
The charity is calling for healthcare records and IT systems across the NHS to be joined up so GPs get an alert if their patient has had emergency treatment for their asthma. Better technology could allow for patients to be automatically booked in for a GP appointment after emergency treatment for an asthma attack.
Until this happens, Asthma UK is encouraging people with asthma to be proactive and urgently book a follow-up appointment with their GP within 48 hours of having an asthma attack. This is particularly important if they have had emergency treatment by a paramedic or at hospital, or had to use a ‘rescue’ pack of steroids.
If people with asthma have difficulty getting a GP appointment, the charity recommends explaining the situation to their surgery receptionist so they are prioritised.***** They could also consider seeing the surgery’s asthma nurse, attend a walk-in centre or call 111 to get expert help.******
Everyone with asthma should also make sure they are taking their asthma medication as prescribed, and can get top tips from Asthma UK’s website.
Lynn Rawes, 43, a clinical support worker from Lancaster, had emergency treatment for an asthma attack in October last year but couldn’t get follow-up treatment from her GP. Three days later she was readmitted to hospital with an asthma attack. She said:
“I was rushed to A&E after a dog allergy triggered a terrifying asthma attack and I was kept in hospital for two days. When I was discharged, I was advised to arrange a follow-up GP appointment, but I couldn’t get an appointment for two weeks. I explained to my GP surgery that I’d had emergency treatment for an asthma attack but they said they couldn’t fit me in.
“Within three days I was in a terrible state. I was wheezing constantly and my reliever inhaler wasn’t helping so I ended up back at A&E and admitted to hospital for another day. Having another asthma attack when I was still recovering from the first was horrendous.
“I know asthma attacks can kill, so I think it’s disgraceful that people like me aren’t getting follow-up care. The NHS needs to make it easier for people- I felt as though I was bouncing from pillar to post just to access the care I needed when I was vulnerable and exhausted. If I’d had a follow-up appointment with my doctor, they could have spotted my asthma symptoms were out of control and helped me manage my asthma so I didn’t end up in hospital again.”
Dr Andy Whittamore, Clinical Lead at Asthma UK and a practising GP, said:
“It’s gravely concerning that so many people with asthma could be missing out on life-saving follow-up care. Once you have had an asthma attack, you are much more vulnerable to having another one. This is because there is more inflammation in your lungs so you are more sensitive to any asthma trigger such as cold weather or pollution. It is vital people see their doctor so they can get the help they need to avoid another asthma attack.
“Patients are slipping through the cracks because NHS systems are letting them down. It is vital that the NHS embraces technology to ensure patients get joined up care. It needs to put systems in place so that patients are automatically given follow-up care if they have had emergency treatment. It could save lives.”
Better information-sharing across the NHS could help to prevent tragic cases like the death of 13-year-old Tamara Mills. She was seen 47 times by different medical professionals across primary and secondary care in the four years before her death, but no one spotted that she was high-risk because her healthcare records were not shared.
To find out more about what to do after an asthma attack, visit www.asthma.org.uk/asthmaattackaftercare
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Notes to Editors
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*Asthma UK surveyed 10,064 people with asthma to ask them if they had had emergency treatment for an asthma attack and if so, if they had received follow-up care. Emergency treatment for an asthma attack can include hospital treatment, A&E treatment and treatment by paramedics. A&E attendances for asthma are estimated to be around 121,000 per year across the UK (The epidemiology, healthcare and societal burden and costs of asthma in the UK and its member nations: analyses of standalone and linked national databases).
If we apply 64% to this figure it is 77,440. For other reference: In 2016/17 (latest figures), 77,855 people with asthma were admitted overnight to hospital with an asthma attack, which means if you apply the proportion of people who didn’t get follow-up care (64%) to this figure it wold be 49,800 people.
** Guidelines from the National Review of Asthma Deaths (NRAD) advises that people who have had emergency treatment for asthma should be treated within 48 hours: Royal College of Physicians, May 2014, Why Asthma Still Kills, p.56, https://www.rcplondon.ac.uk/projects/national-review-asthma-deaths [accessed 07.02.2019]
Guidelines from the National Institute for Health and Care Excellence (NICE) recommends that people who have had emergency treatment for asthma should have follow-up treatment in 2 working days: NICE Quality Standard, February 2013, Quality Statement 4: Follow up by general practice after emergency care, https://www.nice.org.uk/guidance/qs25/chapter/Quality-statement-4-Follow-up-by-general-practice-after-emergency-care [accessed 07.02.19]
*** NHS, https://www.nhs.uk/conditions/asthma/asthma-attack/ [accessed 22 November 2018]
**** NHS Digital, bespoke data request for hospital admissions in England. Between April 2016 and March 2017, 4986 people were readmitted to hospital within 30 days of being admitted for an asthma attack
*****Practice nurses of GPs who do asthma reviews can put a flag on the system so that when a patient calls, the receptionist knows they have asthma and need to be taken seriously and book them an urgent appointment if they call and say they have had an asthma attack
******Asthma UK advises that if a patient has a follow-up with someone who isn’t their GP or practice nurse, they should let their GP know so their records reflect that they had an asthma attack and got follow-up support
About Asthma UK
- In the UK, 5.4 million people are currently receiving treatment for asthma: 1.1 million children (1 in 11) and 4.3 million adults (1 in 12).
- Every day, the lives of three families are devastated by the death of a loved one to an asthma attack, and tragically two thirds of these deaths are preventable.
- Asthma UK’s mission is to stop asthma attacks and 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.
- For more information about asthma please visit www.asthma.org.uk