Five simple steps could reduce future life-threatening asthma attacks and hospital admissions

A national care check list (or ‘care bundle’) is launched today for NHS hospitals discharging asthma patients who have recently received treatment for an acute asthma attack.

Experts believe that successful implementation of just 5 simple steps by hospital staff, could reduce future life-threatening attacks and hospital admissions - saving many lives a year across UK.

The British Thoracic Society (BTS) and Asthma UK, who have jointly produced the initiative, believe hospital discharge is a ‘golden window of opportunity’ to review a patient’s current asthma treatment and care, and promote effective future asthma management.

The initiative was triggered by the recent National Review of Asthma Deaths (NRAD) which found that 10% of asthma deaths happened within just one month of discharge from hospital following asthma treatment.

Recent audits conducted by the British Thoracic Society probing how well NHS hospitals manage children hospitalised for their asthma, found that hospital discharge was poor, with only 53% of children being given a written asthma plan, and less than half checking the patient’s inhaler technique.

A ‘care bundle’ is a simple series of research-based actions, that if systematically delivered by health professionals, can really improve the health of patients. The concept has already been used successfully to improve the care and treatment of chronic lung disease (COPD) patients.

This asthma initiative is targeted at hospital-based health professionals and should be used when asthma patients have passed the normal criteria for being discharged from hospital.

The steps can be taken for all adults and children over the age of two – although children under five may not always be suitable and need special consideration.

The five key actions are these:

1. Assess inhaler technique

All patients (or family members administering medicines) should have their inhaler technique assessed prior to discharge.

This is a critical first step as evidence shows that using an inhaler correctly can radically improve the targeted delivery of treatment to the airways. Good technique is associated with reduced asthma attacks and hospital admissions.

2. Review medication

All patients should have their medications assessed – both the type of drug and its dose.  The importance of taking the right treatment as prescribed should be reinforced with patients and family members.

This step is vital as evidence shows that patients who do not take their ‘preventer’ asthma medication as prescribed can see a deterioration in their symptoms and a reduction in control over their asthma.

3. Provide a written asthma action plan

A written asthma plan should be provided to all patients and their families on how to manage their treatment.

There is strong evidence that the provision of a written plan, in addition to verbal advice, is linked to greater patient understanding of asthma and how to manage it.  This can reduce the risk of further attacks and hospital admissions.

4. Consider factors that might trigger or worsen asthma

Factors that trigger or worsen a patient’s asthma, especially at home or in the workplace, should be considered on discharge.

These include:

• exposure to tobacco smoke and pets at home
• wider issues -  such as a patient’s psycho-social instability due to, for example, mental illness

Explicit attention should be paid to potential triggers in the workplace – which could include exposure to chemicals or other factors.

If triggers are identified, they require follow up and should be included in the patient’s action plan.

5. Deliver timely follow up arrangements in the community

A follow-up appointment at the patient’s GP surgery (or other primary care setting) should be arranged within 2 working days.  An appointment with a hospital specialist should be arranged within a month - or 2 weeks if the patient’s asthma shows clinical indications of needing more urgent review.

Dr John White, BTS member and Consultant Respiratory Physician, York NHS Foundation Trust, who led the group that created the ‘care bundle’, said:

The discharge of asthma patients from hospital provides a golden window of opportunity to review their care and promote effective management of their asthma for the future.  Using all of the latest evidence, we have devised 5 simple and effective actions that hospital-based health professionals can take to promote better patient self-management and reduce hospital readmissions.

Dr Lisa Davies, Consultant Respiratory Physician, University Hospital Aintree NHS Foundation Trust, Liverpool and Chair of the British Thoracic Society’s Executive Committee, said:                                                                    

It is a tragedy that so many people die from asthma each year in UK. It is a treatable disease and we must do much better to tackle it across the NHS.

One way to reduce this tragic toll is to really learn the lessons about why a patient has been admitted to hospital for asthma.  It is often a red flag that something is going wrong in the chain of treatment and care.

I sincerely believe if this ‘care bundle’ is widely adopted across the NHS it could really help to reduce illness from asthma and save lives.

Asthma UK Chief Executive, Kay Boycott, said:

We know more must be done to stop asthma attacks and end complacency in asthma care. If someone ends up in hospital we want them to leave with the right medication, an asthma action plan and knowing that they need to see their GP.

These simple steps, if taken by hospital staff, could make the difference between life and death to people with asthma.