The National Review of Asthma Deaths (NRAD), run by a consortium of asthma professional and patient bodies, led by the Royal College of Physicians, looked into the circumstances surrounding deaths from asthma from 1 February 2012 to 30 January 2013. The NRAD is commissioned by the Healthcare Quality Improvement Partnership (HQIP) on behalf of NHS England, NHS Wales, the Health and Social Care division of the Scottish government, the Department of Health, and the Northern Ireland Department of Health, Social Services and Public Safety (DHSSPS). .

Why asthma still kills report and key recommendations

Why asthma still kills, the report of the National Review of Asthma Deaths was published on 6 May 2014 to coincide with World Asthma Day. The report and its recommendations are available to download at the bottom of this page. The launch slide sets can be downloaded from the NRAD raising awareness page.

There are messages for doctors, nurses, patients, parents and carers in the findings and recommendations of the report. Deficiencies were found in routine asthma care and the review outlines recommendations to be taken forward by not only those who treat patients with this chronic condition but also pharmacists, NHS service managers, policy makers, commissioners and patient and professional bodies.

Why asthma still kills calls for an end to the complacency around asthma care in order to save lives and highlights four key messages:

  • Every hospital and GP practice should have designated, named clinician for asthma services.
  • Better monitoring of asthma control; where loss of control is identified, immediate action is required including escalation of responsibility, treatment change and arrangements for follow-up.
  • Better education is needed for doctors, nurses, patients and carers to make them aware of the risks. They need to be able to recognise the warning signs of poor asthma control and know what to do during an attack.
  • All patients should be provided with a personal asthma action plan (PAAP), which can help them to identify if their asthma is worsening and tell them how and when to seek help.

Background to the NRAD

For a 12-month period from 1 February 2012, deaths from asthma in the UK were reviewed systematically and were subject to an in-depth multidisciplinary confidential enquiry. By engaging with health professionals, the project explored the individual circumstances surrounding the death – for example the medical care received the environmental conditions etc.

It is not clear why the number of deaths per year from asthma in the UK have not reduced significantly from around 1,200 for many years, even though it is widely accepted that there are preventable factors in 90% of deaths. The aim of the project was to understand why people of all ages die from asthma so that recommendations could be made to prevent deaths from asthma in the future.

It was expected that the NRAD would build on previous confidential enquiries into asthma deaths in regions of the UK and provide a more robust body of evidence on which to build our understanding of how life-threatening situations arise and how they can be avoided in future. The learning from the NRAD project will be fed back into clinical practice so that people receive higher quality care and we can reduce deaths from asthma in time, in line with the outcome on reducing mortality from respiratory diseases in the NHS Outcomes Framework 2011/12.

Contact us

Dr Mark L Levy
NRAD clinical lead

Rachael Andrews (nee Davey)
NRAD programme coordinator

Tel: +44 (0)20 3075 1522
Fax: +44 (0)20 7487 3988

­­­­­­­­­­­­­­­­­National Review of Asthma Deaths
Clinical Effectiveness and Evaluation Unit (CEEU)
Clinical Standards Department
Royal College of Physicians
11 St Andrews Place
Regent's Park
London NW1 4LE

NRAD Collaborating partners
Asthma UK National Confidential Enquiry into Patient Outcome and Death (NCEPOD)
British Society for Allergy and Clinical Immunology (BSACI) Paediatric Intensive Care Society (PICS)
British Thoracic Society (BTS) Primary Care Respiratory Society (PCRS)
College of Emergency Medicine Queen Mary, London University
Department of Respiratory Epidemiology, Nottingham Royal College of General Practitioners (RCGP)
Division of Medical & Dental Education, University of Aberdeen Royal College of Nursing (RCN)
Eastern Region Confidential Enquiry of Asthma Deaths Royal College of Paediatrics and Child Health (RCPCH)
Healthcare Quality Improvement Partnership (HQIP) Royal College of Pathologists (RCPath)
Intensive Care Society (ICS) Royal Pharmaceutical Society
National Ambulance Service – Directors of Clinical Care (DOCCSs)

Last updated on: 05 December 2014

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