Tables
- Table 1
Main conclusion of the confidential enquiry panels
Cases n (%) People who died from asthma 195 (71) People who did not have asthma 27 (10) People who had asthma but did not die from it 36 (13) Insufficient information To decide whether the person had asthma 14 (5) To decide whether the person died of asthma 4 (1) Total cases=276.
- Table 2
Demographics
Characteristic# Duration of asthma (n=104) 0–62 years (median 11 years) Age at diagnosis (n=102) 10 months–90 years (median 37 years) Age at death (n=193) 4–97 years (median 58 years) Severity of asthma (n=155)¶ Mild 14 (9%) Moderate 76 (49%) Severe 61 (39%) Previous hospital admission (n=190) 90 (47%) Accident and Emergency attendances (n=115) 40 (34%) Intensive care admissions (n=181) 27 (15%) Current smokers (n=193) 39 (20%)+ Psychosocial and learning disability factors (n=190) 84 (44%) Obesity (BMI ≥30 kg·m−2 at most recent assessment) (n=121) 38 (31%) Data are presented as n (%), unless otherwise stated. #: data return from doctors was incomplete; n assessable data for each parameter are shown in parentheses. ¶: classified by clinicians, 12 out of 28 children and young people (under 20 years-old) were classified with mild or moderate asthma by their clinicians. +: a further 27 (10%) were exposed to smoke at work.
- Table 3
Key findings of the NRAD
1) 195 (71%) out of 276 cases considered by the panels died from asthma; and 27 (10%) had no evidence in their records confirming that they had asthma. 2) The panels concluded that overall asthma management (acute and chronic) was satisfactory in only 31 (16%) out of 195 people who died, and in only one (4%) of the 28 children and young people. 3) The panels identified at least one major potential avoidable factor in 130 (67%) cases out of the 195 who died from asthma. 4) 45% of those who died from asthma either did not call for or receive medical assistance in their final fatal attack. This surprise finding was coupled with the observation that 77% of those who died had no evidence in their medical records of being provided with a PAAP detailing how their medication was to be taken, how to recognise danger signals and when to call for help. 5) The panels identified a number of missed opportunities by the healthcare professionals to intervene and reduce the risk of asthma attacks and death. These were related to: a) Prescribing issues; with overprescribing of short-acting reliever inhalers (SABA) and insufficient provision of inhaled corticosteroid preventer medication b) Failure to monitor asthma control and to provide follow-up assessment and optimisation of medication after asthma attacks; irrespective of whether these were treated in hospital or the community by primary care clinicians c) Failure to refer patients to an asthma specialist (within hospital and from primary care) d) There were potentially avoidable factors related to non-implementation of the current UK BTS/SIGN asthma guidelines [3] in 89 (46%) out of the 195 deaths BTS: British Thoracic Society; SIGN: Scottish Intercollegiate Guidelines Network.
Vol 11 Issue 1
Table of Contents
The national review of asthma deaths: what did we learn and what needs to change?
