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April 2022

Provision of basic care to asthma patients plummets

Seventy per cent of patients with asthma have not received even basic care since the start of the COVID pandemic, according to a survey by Asthma+Lung UK – the lowest rate since 2015.

This means that around 3.8 million people with asthma are not even getting the most basic elements of care.

The move to remote consultations also left many patients behind – fewer patients having an annual review over the phone or by video call were asked about the number of reliever inhalers or courses of oral steroids over the past year, or had their inhaler technique checked than those having face-to-face consultations.

Although inhaler technique checks can be done remotely with the right technology, they are at their lowest level since 2013, the Asthma+Lung UK report, ‘Transforming asthma care in the UK – Fighting back’ states.

‘Despite evidence that poor inhaler technique increases the likelihood of asthma attacks, we found that just 27% of people with uncontrolled asthma had their inhaler technique checked last year,’ the report says.

More than 20% of patients are continuing to use six or more reliever inhalers a year – 1 million rely solely on a reliever inhaler to ‘treat’ their asthma – contrary to national and international guidelines. Almost half (48%) have uncontrolled symptoms that require oral steroids. Less than half of respondents were involved in discussions about treatment options or had their inhaler changed to a higher dose inhaled corticosteroid.

Only about a third (38%) of asthma patients who had emergency or unscheduled care did not have primary care follow up within two days, as recommended by NICE.

Spirometry has not restarted in most parts of the country, and despite investment into increasing uptake of FeNO and creating community diagnostic centres, objective diagnosis of asthma is ‘not happening across the UK’, the charity said.

Asthma deaths have increased by 26% over the last decade, leaving the UK with one of the worst asthma death rates in Europe.

The charity is calling for:

  • Urgent action to increase access to basic care and address the backlog created by the pandemic, and to improve remote care
  • More proactive identification and treatment of people with uncontrolled or difficult asthma through structured assessment in primary care and appropriate referral to specialist services
  • Restarting diagnostic tests in primary care
  • Clear guidance that
    • repeated oral steroid use is a failure of asthma management and should prompt specialist referral
    • combination maintenance and reliever inhalers should be prescribed as alternative to reliever inhalers
  • Increased access to biologic treatments
Practice Nurse 2022;52(4): online only