‘Asthma care is in crisis’ - charity sounds the siren as asthma death toll rises

• Ten years on from National Review of Asthma Deaths, the annual asthma death toll has risen by a quarter, and complacency around asthma has led to thousands of preventable deaths
• New analysis by Asthma + Lung UK shows people with asthma are being failed, with seven out of ten not receiving basic life-saving asthma care 
• Charity calling for urgent government action to end preventable asthma deaths

Over 12,000 people in the UK have died from asthma attacks since the publication of a landmark report ten years ago, which found that the majority of asthma deaths are preventable.¹ Four people die from asthma every day and many more continue to be at risk, with tens of thousands admitted to hospital for life-threatening asthma attacks each year.²

Asthma + Lung UK is calling on the government to introduce national targets to end preventable asthma deaths. The charity says they must also dedicate sufficient funding to implement the upcoming NICE asthma guidelines, ensuring everyone with the condition receives vital basic care. Investment in technology is also essential for the transformation of asthma management, helping people to manage their condition and recognise warning signs, especially those who are less engaged with healthcare services.³

The National Review of Asthma Deaths: Why asthma still kills (NRAD), published by the Royal College of Physicians in 2014, found that two thirds of asthma deaths were preventable.⁴ Key risk factors for death from asthma include overuse of reliever inhalers indicating poorly controlled asthma, underuse of preventer inhalers and recent emergency hospital visits with no follow-up.

But in the decade since the report’s publication, new analysis by Asthma + Lung UK shows that shockingly little has changed for the 5.4 million people in the UK living with asthma. Lack of political will to implement NRAD’s recommendations and complacency around the condition means asthma care is at a standstill. The asthma death rate has actually risen by nearly a quarter and increasingly stretched healthcare professionals don’t have the resources to provide people with the support they need.⁵

Asthma care needs to be focused on treatments that prevent symptoms and asthma attacks (such as preventer inhalers). Most people, if they’re using their prescribed medicines correctly and have regular reviews with medical professionals, can get on with their lives without asthma symptoms getting the way, but if not taken seriously it can be deadly.

Yet, a decade on from its publications, NRAD’s recommendations have not been routinely implemented. While there are some areas of good practice, asthma care still varies widely across regions, with many not receiving the care they need. Research by Asthma + Lung UK found that almost seven out of ten (69%) people surveyed aren’t receiving basic asthma care as recommended by the report.⁶ This should include annual asthma reviews, inhaler technique checks, and written asthma action plans, all of which enable healthcare professionals to support people with asthma so they are doing the right things to keep their asthma under control.

Overuse of reliever inhalers was highlighted in the report as key indicator of poorly controlled asthma which puts people at greater risk of death. Yet new behavioural insight work by Asthma + Lung UK showed that worryingly, nearly a third (31% ) of people surveyed rely on reliever inhaler to manage their condition.⁷

Additionally, follow-up care is woefully inadequate, with a recent study showing that two in three (82%) people are not getting an appointment with a GP or asthma nurse within the recommended 48 hours after an emergency admission, when they are most at risk of another serious attack.⁸ Furthermore, two in five (40%)9 people who ended up in hospital didn’t have a follow-up within 28 days.

Belinda and Ian Dowling from Portsmouth, lost their ten-year old son Warren to asthma attack a year ago. Warren was one of seven siblings. Belinda was pregnant when Warren died, so he never met his youngest sister.

Belinda said: “They say your life can change in a moment and we didn’t know how true that was. Warren mostly managed fine with his asthma, but once or twice a year he’d have a really bad asthma attack and have to go to hospital, which was frightening. Then one evening last March, after he’d been fine in school all day and happily played with his little brother Cameron on the trampoline, he came to me and said he needed his inhaler. It didn’t seem to be working and he started to panic, then while I was on the phone for an ambulance, he turned blue and stopped breathing. His dad did CPR until the ambulance arrived and got him to hospital, but there was nothing they could do to save him.

“Warren was always so happy with a cheeky smile on his face, even if he was getting told off – a real character. His siblings have all been coping in different ways, it comes up at random times. Seven-year-old Cameron asked me the other day why Warren didn’t come back out to play with him on the trampoline, when he’d promised he would.

“There has never been enough awareness of asthma, I want everyone to know how serious asthma is and for no one else to go through what we have. I know Warren would be really happy if his story could help others.”

Sarah MacFadyen, head of policy and external affairs for Asthma + Lung UK, said: “It’s scandalous that ten years on from NRAD’s recommendations to improve asthma care, four people are still dying needlessly from the condition every day. Asthma care is in crisis. People are not getting the care they need and deserve. As a result the UK continues to have one of the worst asthma death rates in Europe. We don’t want to be saying the same thing in another ten years; this is a problem we know how to fix.

“With better care and support, people with asthma could manage their condition well and avoid life-threatening asthma attacks, while investment in research and innovation to develop technology to help people self-manage their asthma, could also be transformative like it has for conditions like diabetes. Not only will these changes save lives and improve people’s health and quality of life, it will also reduce the impact of poorly controlled asthma on health services and help the NHS.”

Dr Andy Whittamore, GP and clinical lead at Asthma + Lung UK, said: “Too often I see people with asthma who have reached a point where they are in danger. They don’t, recognise when they need to seek help, for example when they are using their blue reliever inhaler three or more times a week. It shouldn’t get to the point where someone is rushed to hospital fighting for breath.

“We need a better awareness of the seriousness of asthma, and a focus on supporting people to manage their condition themselves. While healthcare professionals need to have the training, time and resources to understand each individual to ensure they get the basic care they need. Good asthma care can really help people get a handle on their condition, so that it has a minimum impact on their day-to-day lives.”

Dr John Dean, clinical vice president at the Royal College of Physicians, said: “A decade ago, RCP’s report provided a clear blueprint for improvement from leaders in asthma care. Sadly, NHS care in Urgent and Emergency Care, Planned Specialist Care and Primary and Community Care are unable to deliver the care they know people with asthma need. This is unacceptable. Each of these elements needs redesign, and integration to move with patients to a preventive approach, rather than just treating emergencies. This needs political will, and a workforce to deliver it. Clinical leaders are ready to lead that change.

“We echo Asthma + Lung UK’s calls for urgent action. It is critical that the report’s recommendations are revisited and implemented so we can improve patients’ quality of life, prevent further needless deaths, and alleviate additional pressures on an NHS workforce which is stretched to capacity.”

If someone is using their reliever inhaler three times a week or more, it’s a sign of untreated inflammation in their airways and it’s really important for them to make an appointment with their GP, nurse or pharmacist to discuss treatment options. You can also give the Asthma + Lung UK helpline a call on 0300 222 5800 or get information from our website at asthma.org.uk/advice/inhalers-medicines-treatments/.

ENDS

Notes to Editor

The National Review of Asthma Deaths (NRAD), run by a consortium of asthma professional and patient bodies led by the Royal College of Physicians (RCP), looked into the circumstances surrounding deaths from asthma from 1 February 2012 to 30 January 2013.

1 Data via Office for National Statistics (ONS), National Records of Scotland and Northern Ireland Statistics and Research Agency (NISRA). Figure used is the 5 year average of asthma (ICD-10 code: J45-46) deaths 2014-2022. 2014-2022 saw a 23.7% increase in asthma deaths in the UK.

2 Data via bespoke requests to NHS Digital (now NHS England), Public Health Scotland, NHS Wales and Department of Health (Northern Ireland). Asthma (ICD-10 codes J45-J46) emergency admissions below:

Note: Asthma hospital admission rates have remained at over 60,000 every year since the publication of NRAD, peaking at 67,015 in 2018/2019. While there was a dramatic decrease in admissions over 2021/2022, these numbers will have been affected by Covid 19 lockdowns, which meant people with lung conditions caught fewer infections. But admission rates have begun to rise again from 2021/2022. (Figures for 2023 not available).
3. Asthma + Lung UK behavioural insights work found that 31% of people are disengaged with managing their asthma, putting them at higher risk of a potentially life threatening asthma attack. 
4. Figure via Why Asthma Still Kills: The National Review of Asthma Deaths; Royal College of Physicians. 65% of asthma deaths had one or more avoidable factor (Table 6.3.1).
5. Data via Office for National Statistics (ONS), National Records of Scotland and Northern Ireland Statistics and Research Agency (NISRA). Figure used is the 5 year average of asthma (ICD-10 code: J45-46) deaths 2014-2022. 2014-2022 saw a 23.7% increase in asthma deaths in the UK. Available on request. 
6. Data from asthma respondents in Asthma + Lung UK’s Life with a Lung Condition Survey 2024.Basic asthma care is defined as receiving all of: an annual asthma review, an inhaler technique check and a written asthma action plan. 

7. Asthma + Lung UK. 2023. Asthma Behavioural Insights: Workshop [PowerPoint presentation]. Available on request. (March 2024) Slide 22. 
8. Post-hospitalisation asthma management in primary care: a retrospective cohort study | British Journal of General Practice (bjgp.org)