National review of asthma deaths in the UK 2014

Why asthma still kills is the National Review of Asthma Deaths’ (NRAD) first national investigation of asthma deaths in the UK and the largest study worldwide to date. The primary aim was to understand the circumstances surrounding asthma deaths in order to identify avoidable factors and make recommendations to improve care and reduce the number of deaths.

The review found deficiencies in both the routine care of asthma patients and the treatment of attacks. In many instances, neither doctors nor patients recognised the signs of deteriorating asthma; they also did not react quickly enough when these were seen.
Key findings include the following.
• During the final, fatal asthma attack, almost half of those who died did so without seeking medical help, or before emergency care could be provided.
• Around one-fifth of those who died had attended a hospital emergency department for asthma at least once in the previous year.
• Ten per cent died within 1 month of being discharged from hospital for asthma.
• Many of those who died were being treated for mild or moderate asthma. Experts concluded that most of these actually had poorly controlled, severe asthma, but neither the patients nor their doctors recognised this.
• There was widespread over-reliance on reliever inhalers and underuse of preventer inhalers in those who died.
• Nearly half of those who died had not had an asthma review by their GP or nurse in the previous year.
• Around one-fifth of those who died were smokers, and this was thought by experts to have aggravated their asthma; others were exposed to second-hand smoke at home.