I was very saddened to read the media coverage of the large rise in the number of those who die due to asthma attacks. (1)
I am not surprised. I warned them that this was coming but that comes in part (2).
On looking at the press articles it appears that the charity Asthma UK and clinicians are blaming poor care. Others are blaming the rise in air pollution.
Poor care is commonly blamed on poor funding for health care services. In the UK healthcare for citizens is paid for by the taxpayer and is free at the point of need. It’s called the National Health Service-the envy of the world.
When I was a 3rd-year medical student I attended a lecture where the clinical director of a hospital said that as a final year medical student he couldn’t understand why there was a conflict between NHS management and clinicians over funding. Some 30 years later he still could not understand why there was such a conflict. The reason is very simple.
Well organised good quality clinical medicine is value for money medicine.
In every clinical situation, the best clinical care is always, without exception, the cheapest option.
Asthma in the community
Most cases of asthma are managed in the community. Let me tell you the gold standard.
All patients are to be advised to keep a peak flow diary so they can monitor the control of their asthma.
All patients are to carry an inhaler of salbutamol at all times. If the patient needs to take it more than twice a day then the clinical condition needs to be reviewed. 3/4 of asthma patients are on PRN (as and when required) salbutamol. Another 1/5 are taking the Beconase inhaler once a day as a preventer. If the patient needs more than this then a referral to a specialist is needed.
All patients are to be seen every 3 months for a review by their family doctor. In the UK such doctors are called General Practitioners (GPs.) My Dad was a GP and during his working life, all patients with a long term medical condition were seen every 3 months for a review. That kept their signs and symptoms under control, minimising hospital referrals and admissions.
Most importantly all patients with a long term condition should be highly educated on their condition so that within 6 months they know more about their condition than their doctor does. I have actually treated the odd such patient. Such people get regular magazines, go to regular lectures and attend seminars on asthma. They control asthma so well that on the 3 monthly reviews it’s a case of this scenario.
Doctor “Nice to see you. How are things.” Patient “No change, no symptoms”
Doctor “Shall we just keep you on the PRN salbutamol?”
Doctor “I just need to do a quick examination and check your peak flow diary.”
5 minutes later.
Doctor “All normal, no change. Anything else.”
Doctor “OK, see you in 3 months.”
Many of my Dad’s patients with long term conditions were like this. Total health care cost to the taxpayer- minimal.
Asthma emergencies in hospital
One of my tutors, when I was a medical student, told me that the commonest cause of death with asthma was lack of oxygenation. Commonly in those days patients were started on 24% oxygen and titrated upwards if the situation got worse. Air is 21% oxygen so giving people 24% is basically giving air.
My Dad taught me to give 100% oxygen, give them intravenous steroid (although it took a few hours to work) and nebulised salbutamol. Not one of my patients ever ended up in intensive care.
Makes you think, doesn’t it?
In conclusion, this 33% rise in asthma deaths did not need to occur. In another article I will deal with the rise of traffic pollution and I will detail how we can slash traffic pollution literally overnight with minimal cost.
An Ounce of Asthma Prevention Avoid asthma attacks by taking these steps http://jamesbondhealthandfitness.fitpromag.com/3/1/2018/Article/?article=1543
(1) BMJ 2019; 366 doi: https://doi.org/10.1136/bmj.l5108 (Published 09 August 2019)
(2) Asthma deaths have increased by a third in a decade as hot summers, air pollution and lack of care blamed https://www.telegraph.co.uk/news/2019/08/08/asthma-deaths-have-increased-third-decade-hot-summers-air-pollution/