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Table 2 Recommendations to reduce risk of asthma death

From: An imperfect “PAST” Lessons learned from the National Review of Asthma Deaths (NRAD) UK

Risk Factor

Recommendation

1. 45 % died at home without calling for help and Personal Asthma Action Plans (PAAPs) had only been issued to 23 %

All patients with asthma to be issued with PAAPs to include

• asthma triggers,

• current therapy,

• advice on treatment escalation and

• how to call for help

2. Failure to phenotype asthma or identify triggers in >51 %

Asthma clinical phenotyping to identify likely triggers and underlying mechanism of asthma

3. No evidence of a review in general practice in the last yr for 43 %

Structured annual review of asthma control preferably timed a month before expected seasonal exacerbation

4. 10 % died within 28d of hospital discharge and 21 % died within 12mo of attendance in ED

Follow-up arranged following every attendance in ED and secondary care follow-up after each hospital admission for asthma

5. Excessive prescribing of SABA (39 % issued with >12 devices in previous 12mo) inadequate uptake of ICS with 38 % issued <4 devices in previous 12 mo

Electronic surveillance of inhaler prescribing in primary care to identify those prescribed >12 short-acting beta-agonist or < 4 corticosteroid inhaler devices in previous yr