UK asthma care: £1 billion well spent?
Asthma, and its associated care, has been under intense scrutiny in the media lately. Such attention is warranted, given that £1.1 billion is spent on Asthma care by the NHS each year(1). Some headlines have leant towards scandal, implying potential misspending of public funds such as “Asthma inhalers given out almost as a ‘fashion accessory’” from the Guardian. (2 ), And perhaps such inflammatory language is justified, as the NHS itself admits that “1/3 of adults treated for asthma may not actually have the disease”(3). This represents the first hurdle of care for any asthma patient; diagnosis. Researchers from a study published in the British Journal of General Practice concluded "over-diagnosis of asthma was found in more than half of one million children, leading to unnecessary treatment, disease burden, and impact on their quality of life.”(4) One might ask then why we are not focusing on developing more accurate diagnosis testing, in order to avoid spending money on people who don’t actually have the disease. Not to mention that the medication they are being prescribed can have side effects. However, anyone with asthma will know the symptoms are very variable, dependent upon what and when it is triggered. If GPs were to be more cautious in their prescribing, there could be a risk of some patients having dangerous, even fatal attacks. We cannot lose sight of the fact that asthma is a chronic disease.
Once diagnosed, assuming the patient actually has asthma, the next struggle of care: self-management. Asthma UK have found a direct correlation between good management and quality of life, yet many patients with asthma are reluctant to take time to record their triggers, take their preventative medication and try to push themselves sensibly to their limits and goals. Most prefer to try leading a normal life and cope with the symptoms they experience along the way. It doesn’t have to be like this – 38 per cent of under-controlled asthmatics said it has a significant impact on their free time compared to just 2% of those whose asthma is well-managed(5).
So where does improvement in asthma treatment and management lie? A trip to A&E could be made 4 times less likely if patients adhered to a written action plan. Written action plans are supposedly produced during an annual GP review session. However the Patient Information Forum found that only 42% of patients actually receive one.(6) GP’s are busy people, so if the patient is unreceptive to commit to a plan, this might discourage GPs from pursuing it.
The risks to people who have poorly controlled asthma are not insignificant. On average, 3 people die from asthma every day in the UK. Nevertheless, 2 out of 3 of these deaths are preventable if asthmatics are given access to basic care.(7) According to Dr Andy Whittamore,“Good asthma care means having a thorough asthma review, being on the right medication, knowing how to use your inhaler correctly and having a written asthma action plan.”(8) There is no fundamental reason why this care should not be achievable in the UK, given that each element already exists, albeit within an NHS that is under considerable financial pressure. This leads us back to the beginning, trying not to overspend asthma funds on people who don’t actually have the condition, whilst offering appropriate support for people who do.
Is there a better future for asthma care? Whilst an outright cure doesn’t seem to be on the horizon, there are some developments that may offer treatment help to asthmatics. One such technological advancement is “smart inhalers”. Kay Boycott from Asthma UK believes that they are “a game changer.”(9) Smart inhalers are capable of giving more accessible and timely feedback on inhalation technique and medicine adherence. This information can be made available to a GP or asthma nurse who can in turn check that a patient is following their action plan (if they have one…). Such advances in technology are unlikely to be a panacea, but at least by seeking to automate and track asthma experience, they could potentially contribute to making asthma care more affordable and effective for everyone.
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