Increasing fatalities due to asthma leave experts baffled

Illness registry including audit of deaths proposed in 2016 – but yet to receive funding

People at risk of an asthma attack include “those who are exposed to tobacco smoke”.

People at risk of an asthma attack include “those who are exposed to tobacco smoke”.

 

Deaths from asthma in Ireland have increased by 40 per cent while an inquiry to help shed light on why deaths are occurring has been rejected by the Health Service Executive for being “too expensive”.

Asthma deaths, 90 per cent of which are preventable, ranged from 46-50 per annum in the past. But in recent years they have jumped to about 70 deaths annually, according to respiratory physician Prof Pat Manning, HSE national clinical lead for asthma.

“We are not sure why this is happening. There is an increase in deaths in the younger population, which is a concern. Asthma deaths are something that shouldn’t happen,” said Prof Manning.

Ireland has the fourth highest rate of asthma prevalence in the world and nearly half a million Irish adults and children suffer from the condition.

An Irish asthma registry, including an audit of asthma deaths, was initially proposed in 2016 but has yet to receive funding due to cost concerns.

“We were initially asked to develop a submission to undertake an audit of asthma deaths . . . but that was deemed too expensive so we re-did it. But it hasn’t got off the ground yet,” said Prof Manning.

However, the HSE asthma programme is now working with the Royal College of Surgeons in Ireland audit office to see how they can progress an audit.

Reducing fatalities

Unlike other countries, Ireland does not audit asthma deaths. Such an exercise would help unearth reasons why individuals die from the condition and thereby help reduce deaths.

Fatalities frequently occur in those aged between 13 and 30 years, with the majority of such patients diagnosed with mild to moderate asthma.

The submission to undertake an audit of asthma deaths was made by the HSE Asthma Programme. It was modelled on the Royal College of Physicians Review of Asthma Deaths in the UK.

“Hopefully we will see deaths fall when the audit is in place, as [it] will identify causes of deaths in young and old people and we can then identify areas for improvement to help reduce deaths,” said Prof Manning.

The Asthma Society of Ireland has called for a mortality audit to help increase knowledge around why such deaths occur.

Ruth Morrow, advanced nurse practitioner with a special interest in respiratory care, said the asthma “cycle of care” for children aged under six is  not equipped to deal with the needs of children experiencing acute asthma exacerbations.

Introduced in primary care in 2015, she maintained the free service “is inappropriate and does not address the needs of those at increased risk of acute asthma flare-ups”.

She called for the availability of asthma care “on a needs basis” and said care should not be means tested.

Those at risk

“Preventative medication should be . . . available for all people with asthma. What these patients require is structured education, regular follow-up and support delivered in primary care,” said Ms Morrow.

“Those at increased risk of acute asthma flares include adolescents, patients who have had a flare-up in the last year, those who do not adhere to medication regimes, those with poor inhaler technique, those whose flare up season is September-October and those who are exposed to tobacco smoke.”

In response to the criticism, Prof Manning said there was an opportunity to introduce the asthma cycle of care when free GP care for children aged under six was implemented.

He said the aim is to offer this to all children under 12 and, subsequently, to all asthmatics, pending the development of a new GP contract.

In 2017 the number of asthma inpatient discharges was 5,200, while 20,000 attendances in emergency departments were due to asthma. About 50,000 out-of-hours GP attendances for uncontrolled asthma occurred last year.