Editor,
In May 2014, the RCP National Review of asthma deaths was published, entitled “Why asthma still kills”1. The report reviewed asthma deaths in the four UK countries over a 12 month period. One recommendation was that all asthma patients who have been prescribed more than 12 short acting beta agonist (SABA) reliever inhalers in the previous 12 months should be invited for urgent review of their asthma control2.
Following on from this report, I conducted an audit of SABA overuse in asthmatics in a GP practice in West Belfast during my FY2 rotation.
Method
An EMIS search was conducted of asthma patients who had been prescribed 12 or more salbutamol inhalers from January 2014- 2015. Patients were contacted by telephone or sent a letter to invite them to attend for review of their asthma-starting with those issued the highest quantity of SABA inhalers. They were reviewed by FY2, practice pharmacist and two practice nurses.
Results
The total number of asthmatic patients prescribed salbutamol in the Year 2014-2015 was 576, with 145 prescribed 12 or more inhalers (25%). The largest quantity issued to a single patient was 44. The table below demonstrates the breakdown of number of inhalers prescribed.
| Number of inhalers prescribed | Number of patients |
|---|---|
| 12 | 31 |
| 13-19 | 51 |
| 20-29 | 41 |
| 30-39 | 20 |
| 40+ | 2 |
From January-March 2015, 98/145 had been offered appointments or contacted via telephone about their SABA overuse. 46/98 had a review and discussion about their asthma. Those who have failed to attend for review and had been receiving > 1 inhaler per prescription had their prescription reduced to 1 inhaler per script, with a note to make an appointment for review of their usage.
Discussion
This audit suggested that around ¼ of asthmatics in the practice were poorly controlled. On further review, a large number had failed to attend for an annual asthma review (45%). In those patients reviewed between January and March, their SABA usage had started to reduce over the 3 month period. At review, they were assessed using the BTS/ SIGN guidelines, which cover a spectrum of areas. It was evident that education was very important for them. They were provided with a personal asthma action plan to refer to if they became symptomatic. This audit was presented at the monthly practice meeting in order to update the GP partners and highlight the issue. We would recommend vigilance when prescribing inhalers – those with excessive usage may benefit from education and personal action plans with the goal of reducing avoidable mortality.
The authors have no conflict of interest.
REFERENCES
- 1.Levy ML, Andrews R, Buckingham R, Evans H, Francis C, Houston R, et al. Confidential Enquiry report. London: Royal College of Physicians; 2014. Why asthma still kills: The National Review of Asthma Deaths (NRAD) Available online from: www.rcplondon.ac.uk/sites/default/files/why-asthma-still-kills-full-report.pdf Last accessed September 2016. [Google Scholar]
- 2.Regional Pharmacy and Medicines Management Team . The National Review of Asthma Deaths (NRAD) Belfast: HSC Northern Ireland Formulary Medicines management; 2015. Newsletter supplement: Why Asthma Still Kills. Available online from: http://niformulary.hscni.net/PrescribingNewsletters/PDF/NIMM_2015/NIMM_%20NewsletterspecialSupplement_Jan15.pdf Last accessed September 2016. [Google Scholar]