Asthma deaths - an avoidable tragedy?
Is your asthma inhaler unsafe? That's the question being asked by Asthma UK, after looking at the medical records of nearly 100,000 UK patients. They conclude that some patients aren't being treated with the right inhalers, and that doctors are missing warning signs that some asthma patients' control is putting them at risk of life-threatening asthma attacks.
Overall, they estimate that 'tens of thousands' of patients could be affected - a small but important proportion of the estimated 5.4 million sufferers in the UK. At least one in 10 children and one in 20 adults in the UK have asthma. It often runs in families, and people with other 'atopic' conditions like eczema and hay fever are also more likely to be affected. Severe hay fever symptoms can make asthma worse, and in the last few weeks I've seen an unusually high number of patients whose regular hay fever treatment isn't working as well as usual. Most hay fever sufferers are allergic to grass pollen, and the annual misery of blocked/runny nose, itchy eyes and throat is usually at a peak between May and July.
But back to asthma. Symptoms can range from getting slightly wheezy when you have a cold, exercise or handle a fluffy rabbit, to constant shortness of breath, wheezing, chest tightness and coughing that stops you functioning. Warning signs of a severe asthma attack in adults include:
- Not getting relief from your 'reliever' inhaler
- Being too breathless to speak whole sentences
- A drop in your peak flow rate to below 50% of your best level
- Rapid heart rate (110 beats a minute or more)
- Rapid breathing (25 breaths or more a minute).
In the UK, asthma control is often assessed using the 'Royal College of Physicians' 3 questions':
In the last week/month:
- Have you had difficulty sleeping because of your asthma symptoms (including cough)?
- Have you had your usual asthma symptoms during the day (cough, wheeze, chest tightness or breathlessness)?
- Has your asthma interfered with your usual activities (eg, housework, work/school etc)?
With good asthma control, the answer to all these questions should be no. If it's not, you should be speaking to your doctor or nurse about your medication. In the UK, recommended treatments are used in a step-wise fashion. In the mildest cases, you use a short-acting 'reliever' inhaler like salbutamol or terbutaline just when you have symptoms, or sometimes before you do something (such as exercise) which sometimes brings on your symptoms.
If you're needing to use your inhaler more than once every couple of days, you should start using a 'preventer' inhaler using a small dose of steroid, which reduces inflammation in the lungs. Next comes the addition of 'long-acting' reliever medicine, often given in a combination inhaler with the steroid. These long-acting relievers should never be prescribed without an inhaled preventer steroid medication. If this combination isn't controlling your asthma there are several other options for treatment, depending on your symptoms and preferences.
Even if your asthma is really well controlled, you should have your symptoms and your medication reviewed at least once a year, including getting a check of how you use your inhalers. It never ceases to amaze me, even after 25 years as a GP, how many people don't get the best from their inhalers because they're not using them properly. Your GP or nurse can guide you on which other inhaler might work better for you if you're having trouble using your current one.
Asthma isn't always a 'mild' condition - in severe cases it can take over your life or even kill. But neither is it a hopeless case. Some people have extremely severe asthma which can be hard to control even under strict specialist guidance. But many hospital admissions and even deaths from asthma are avoidable. The message is clear - if your treatment isn't controlling your symptoms, it's time to work with your doctor to take control.