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Asthma on the agenda

Marilyn Eveleigh
Consultant Editor

It is not a perfect world and there are examples of apparent national unfairness that we could all cite - dustbins that are emptied weekly and others only fortnightly, the nursing pay award that is made in full except in England, and the postcode lottery of who pays for the elderly in nursing homes, are some current "hot topics".
If you know anyone with asthma (and everyone of us does), then you will want to add the dramatic national variations for emergency admissions to your list of "unfair". The Asthma Divide, published in May 2007, illustrates the huge differences across the country of hospital admissions for acute asthma - and the financial implications.
For example:

  • North West England has six times the hospital admissions than the East region. 
  • Patients with asthma living in the north west are 65% more likely to have asthma that is not controlled and that requires hospital admission than those living in the east. Some PCTs have half the national average of hospital admissions, while others have twice the national average of admissions.
  • It costs 3.5 times more to care for an asthmatic with an acute attack than for one who is well managed.
  • Hospital management cost £58.3m in 2004.
  • There were 59,859 asthma admissions in 2004 - one every eight minutes.
  • One in six hospital admissions require further emergency care within two weeks.

These may be hospital statistics but they reflect and impact on us all in healthcare.   
With the appropriate knowledge and use of medicines, the majority of people with asthma are able to control their condition. Proactive and tailored asthma reviews should be the expectation of all asthmatics.   Patients with asthma should have their own personal action plan that guides their drug management and indicates when to seek medical help. With this in place it is estimated that 75% of hospital admissions would be avoidable.
Yet recent evidence suggests that one quarter of hospital asthma admissions receive no information about follow-up - and one in 10 are unaware what to do if they have another attack. Patients with asthma have reported that fear of an attack blights their lives.
This is a challenge for primary and community healthcare whether we are the frontline clinician or have opportunistic contact. This edition of NiP has a focus on asthma that will support this challenge. The charity Asthma UK voices patients' perspectives and, using that insight, we need to listen and ask ourselves and our patients if they feel supported by our care.
Too often we assume practice nurses and GPs are managing the patient and their asthma: too often they fail to see the patients most in need. Patients who consider their asthma does not merit review, the worried well often dominate appointments and the timing of appointments/clinics are difficult for patients to attend. Asthma hospital admissions indicate primary care has not got asthma under control.
We need to reconsider our practice in primary care:
Compared with the white population, asthmatics of South East Asian origin are three times more likely to have an asthma admission, with Afro-Carribeans having double the rate.

  • Patients without written personalised asthma action plans are four times more likely to be admitted.
  • Social deprivation is associated with higher admission rates for acute asthma.
  • PCTs that had the highest QOF scores for asthma had fewer hospital admissions.

This is a challenge we can address immediately - targeting and prioritising those asthmatics most at risk in our caseload.