Tens of thousands at risk of potentially life threatening asthma attacks from unsafe prescribing

Last year's National Review of Asthma Deaths [1] highlighted prescribing errors in nearly half of asthma deaths in primary care (47%). Now new analysis from Asthma UK, based on data from over 500 UK GP practices [2], reveals evidence that over 22,000 people with asthma in the UK, including 2,000 children, have been prescribed medicines (long-acting reliever inhalers) in a way that is so unsafe they have a 'black box warning' in the USA due to the risk they pose to the lives of people with asthma [3]. In addition, the report indicates that almost 100,000 people with asthma have been prescribed too many short-acting reliever inhalers (more than 12 in a year) without national clinical guidelines being followed [4], leaving them at risk of life threatening asthma attacks.

Asthma medication is safe, but it is dangerous to use a long-acting reliever inhaler alone (without a steroid preventer inhaler or as a combination inhaler). This is because a long-acting reliever inhaler helps to keep the airways open but does not treat the underlying inflammation. This leaves the airways of people with asthma inflamed and more likely to react to triggers such as pollen or pollution, putting them at risk of having a potentially life-threatening asthma attack. If someone with asthma is prescribed more than 12 short-acting reliever inhalers in a year (using it more than 3 times each week) without seeing a doctor it is a key indicator that they are not managing their condition and that their treatment needs reviewing.

Kay Boycott, Chief Executive of Asthma UK, says: "It is simply unacceptable that the lives of people with asthma are being put at risk because of unsafe prescribing. The UK has some of the highest mortality rates for asthma in Western Europe and the levels of unsafe prescribing identified in our report today must be stopped. It is crucial that healthcare professionals review their systems and urgently recall patients who have been prescribed long-acting reliever inhalers on their own without a steroid preventer, or not as a combination inhaler. NHS bodies must ensure systems are in place to stop unsafe asthma prescribing from happening and implement all the recommendations from the National Review of Asthma Deaths to improve patient safety and end complacency in asthma care."

Ms Boycott adds: "Anyone with asthma who is concerned by these findings should try not to worry they are not in any immediate danger. However, it is important that people with asthma really understand their medicines and take an active role in managing their medication. They should check if their inhaler includes Salmeterol, Formoterol or Tiotropium bromide as the only active ingredient. If they are taking this without a steroid preventer inhaler, or not as a combination inhaler, they need to contact their GP right away. Anyone who is using their reliever inhaler more than 3 times a week and hasn't had a recent review should contact their GP as soon as possible. If people are not sure if this applies to them, they should visit the Asthma UK website for more information or call the Asthma UK Helpline for advice and support on 0300 222 5800."

Dr Mark Levy, GP and author of The National Review of Asthma Deaths, says: "Asthma UK's report is welcome as it echoes the findings from the National Review of Asthma Deaths. There is widespread failure to recognise risk of attacks and therefore asthma death. Yet the reality is that deaths can be prevented when symptoms are managed effectively, with safe use of asthma medicines and in partnership with the patient."

Asthma UK Checklist

Don't stop taking your medication you are not at immediate risk. These simple steps will help you to actively manage your medicines

Am I taking medication with a 'black box' warning in the USA?

  • The first thing to do is to check if you are using an inhaler which has Salmeterol, Formoterol or Tiotropium bromide as the only active ingredient. If you are taking this without a steroid preventer inhaler, or not as a combination inhaler, then you need to contact your GP right away. If you are not sure if this is you, then visit the Asthma UK website for more information about inhalers and health advice about managing your medicines: www.asthma.org.uk
  • If you cannot book an appointment right away with your GP, you can also call the Asthma UK Helpline on 0300 222 5800 for advice and support (Monday to Friday 9am until 5pm).

Taking more than 12 reliever inhalers a year?

If you are using your reliever inhaler (often a blue colour) more than 3 times a week (using more than 1 inhaler a month) its a sign your asthma is not well controlled. If this is you, book an asthma review with your GP as soon as possible.

If you cannot book an appointment right away, visit the Asthma UK website for more information: www.asthma.org.uk.

You can also call the Asthma UK Helpline nurses on 0300 222 5800 for advice and support (Monday to Friday 9am until 5pm).

Notes to editors:

Data sources

  1. Why asthma still kills: the National Review of Asthma Deaths. A list of avoidable factors. Note: Avoidable factors relating to prescribing were identified by the panels in 47% of the cases managed in primary care. P. 60, section 8
  2. The report findings are based on data from the Optimum Patient Care Research Database, which was analysed by Asthma UK, in collaboration with Optimum Patient Care Ltd and the Respiratory Effectiveness Group, and published in 2015: Lewis C., Humphreys E., Chisholm A., Carter V. Price D. (2015) Evidence of poor prescribing in asthma care. Respiratory Effectiveness Group Asia-Pacific summit, Singapore. Data extracted during 2010-2013, sample size of 94,955, sourced from GP Practice systems in England (456), Scotland (54), Wales (5) and Northern Ireland (5). Total number of incidents are estimated by calculating the relevant sample percentage for adults, children and all and applying this to the corresponding asthma populations in the UK. The OPCRD is a quality controlled, voluntary GP Practice database and can therefore not be guaranteed to be representative of the UK population.
  3. What is a black-box warning? Black-box warnings take their name from the black border around the information and are The Food and Drug Administration (FDA's) most stringent warning a drug can carry before it is pulled from the shelves
  4. Prescribed without a healthcare professional reviewing their condition and assessing why their asthma control is poor. This is a sign that someone with asthma is over-relying on their short-acting reliever inhaler and not staying on top of their condition.

Where do I go for advice and information

What are long-acting reliever inhalers?

The long-acting reliever inhalers include:

  • Serevent Evohaler (Salmeterol), Serevent Accuhaler (Salmeterol), Vertine Metered-Dose Inhaler (Salmeterol), Formoterol Easyhaler (Formoterol), Oxis Turbohaler (Formoterol), Foradil Dry Powder Inhaler (Formoterol), Atimos Modulite Metered-Dose Inhaler (Formoterol), Spiriva Respimat (Tiotropium)
  • Long-acting reliever inhalers keep your airways opened up by relaxing the muscles around them. This helps you breathe more easily. Long-acting muscarinic receptor antagonist (LAMA) inhalers and long-acting beta agonists (LABA) have also been shown to reduce the amount of mucus produced in your airways.
  • It is dangerous to use a long-acting reliever inhaler without a steroid preventer inhaler. This is because a long-acting reliever inhaler helps to keep your airways open, but doesn't treat the underlying inflammation in your airways. The inflammation makes your airways more sensitive and irritable. Without using a steroid preventer inhaler alongside a long-acting reliever inhaler, this underlying inflammation will just get worse and worse. This means your airways are more sensitive to your asthma triggers, and more likely to react to them, putting you at an increased risk of an asthma attack.

What are the short-acting reliever inhalers?

The short-acting reliever inhalers include:

  • Ventolin Evohaler (Salbutamol), Ventolin Metered-Dose Inhaler (Salbutamol), Ventolin Accuhaler (Salbutamol), Pulvinal Salbutamol (Salbutamol), Easyhaler Salbutamol (Salbutamol) , Airomir Metered-Dose Inhaler (Salbutamol), Airomir Autohaler (Salbutamol), Salamol Metered-Dose Inhaler (Salbutamol), Salamol Easi-Breathe (Salbutamol), Salbulin Novolizer (Salbutamol), Bricanyl Turbohaler (Turbutaline)

About Asthma UK

  • 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.
  • Asthma UK is solely funded by public donations.
  • The Asthma UK Helpline is open weekdays from 9am to 5pm on 0300 222 5800.
  • For more information about asthma please visit www.asthma.org.uk.

Background information on asthma