‘All asthma deaths should be preventable’: New checklist for GPs

Amanda Lyons

15/10/2019 1:41:56 PM

Deaths from asthma have fallen significantly, but the National Asthma Council hopes its new resource will help to reduce numbers even further.

Inhaler spacer
The checklist includes a list of common issues for people experiencing asthma, including correct inhaler technique.

Asthma deaths are trending in the right direction.
The numbers of such deaths in Australia have dropped significantly over the past several years, from 457 in 2016 to 441 in 2017, and even further to 389 in 2018.
This reduction is undoubtedly good news, but Dr Ian Almond, GP spokesperson for the National Asthma Council (NAC), remains concerned the numbers are still too high.
‘All asthma deaths should be preventable, in a perfect world,’ he told newsGP.
‘But you can get a constellation of events that cause a real problem – the wrong things happening at the wrong time and not having the optimum medication to put it to rest.’
The NAC wants to highlight to GPs that they now have assistance in helping patients identify and manage their asthma and its degree of severity with its new resource, the Severe asthma checklist.
Described as concise and to-the-point, the checklist is designed to guide GPs through the key steps of management of severe asthma, from diagnosis through to specialist referral for the small percentage of those who experience difficult-to-manage asthma.
‘It provides a summary of all the information that’s available in the NAC handbook, in a format that is easy-to-use, practical, and provides benefits for the treating GP and, more importantly for the person with asthma, in that they will be getting the improvement of the treatment,’ Dr Almond said.
‘The front side gives a nice synopsis, so that you can run through the checklist to make sure you cover all the boxes and are getting all the information you need to make the diagnosis of the stage of asthma the individual has and how they might best be managed.
‘Then the detail is on the other side, reminding us of asthma plans and how you use the checklist to get the information you’re going to need and use.’

While decreasing numbers of asthma-related deaths is positive, Dr Ian Almond, GP spokesperson for the National Asthma Council (NAC), remains concerned they are still too high.

One of the most notorious asthma-related events in recent years was the thunderstorm asthma epidemic that struck Melbourne in 2016, resulting in the deaths of 10 people, most of whom had not been previously diagnosed with the disease.
Dr Almond believes this event did help to raise awareness about the perils of asthma, likely contributing (in addition to improvements in treatment and medications) to the reduction in asthma-related deaths. But he remains worried asthma is too often underestimated by patients.
‘People are willing to accept a little bit of recklessness or difficulty or encroachment on their lifestyle as the accepted thing, so there is a lot of sub-optimal asthma management,’ Dr Almond said.
‘They think, “I’m going to get a bit of a wheeze now and again, but I’m not going to die from it”.
‘But the reality can be a lot worse and more fatal than that.’
Dr Almond has also often found misunderstanding among patients regarding treatment options, including which might be best for their particular condition.
‘All professionals have had the issue of trying to get people to understand the difference between a reliever and a preventer,’ he said.
‘People are happy to run with a short-acting beta agonist and that’s all they think they need, because they don’t understand the physiology and pathology behind repeated attacks and the damage that’s done, and that if you prevent an event or a flare-up in the first place, you can actually keep the lungs in better condition.’
Dr Almond also understands the challenge GPs can face in treating and managing the disease.
‘There’s a lot of repetition in managing asthma, and sometimes you’re time-poor and it’s difficult,’ he said.
‘But we need to document it properly, spirometry being the gold standard. And if new medication is being trialled, it’s worthwhile making sure somebody is improving, which can be measured by repetition of spirometry.’
The new NAC checklist also includes a list of common issues for people experiencing this asthma stage, such as adherence, inhaler technique, comorbidities, triggers and the potential for reliever overuse, helping GPs to identify the best course of action.
‘While it’s important to ensure that those who could benefit from new treatments are identified correctly and referred promptly, it’s equally important to identify people whose uncontrolled asthma is potentially due to other causes, such as comorbidities or poor adherence, so that these issues can be addressed,’ Dr Almond said.

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A.Prof Christopher David Hogan   16/10/2019 9:45:53 AM

As can be seen the list is thorough & involves a lot more than "How is your asthma?"
I started practice well before many modern treatments were available & sadly have seen people die because they did not follow medical advice.
I heartily endorse the need for thorough discussion & interaction with patients & their informal carers so that they understand asthma management, regular review of device use techniques & spirometry.
However, to say that asthma deaths should be preventable is optimistic. Sometimes, in spite of maximal intervention, people die & there is no point burdening their care givers with the suspicion that they somehow failed. As an expert witness, many years ago, I have testified to the coroner on several instances that all that was then humanly possible had been done. (I also acknowledge there were many, many more instances when deaths were definitely preventable)