Asthma
Introduction
Asthma is a long term condition which affects the airways in the lungs and causes breathlessness, tightness in the chest, wheezing and coughing. The severity of the symptoms varies from person to person from mild to severe. Asthma is an inflammation of the airways, specifically the bronchi.
People with asthma often have one or more ‘triggers’, which irritates, airways causing them to tighten and the bronchi to produce excess mucus. Triggers include smoking, pollen, cold air and exercise. Asthma is both treatable and preventable by prescribed inhalers, medicines or other treatments. Poor management of the condition leads to ongoing health problems for individuals and can also be a cost burden to the NHS.
Key inequalities and risk factors
Commissioners and service providers should be mindful of the following factors which influence asthma incidence and prevalence:
- Age – Starting smoking as a teenager increases the risk of persisting asthma.
- Air quality – Inhale 2013 state that urban patients are more likely to be admitted to hospital for asthma than rural patients.
- Breastfeeding – whilst there is no conclusive evidence, the weight of evidence is in favour of breast feeding as a preventive strategy.
- Diabetes – A large study in paediatrics showed that children with diabetes are more inclined to develop asthma, and also that young children, who may have both conditions, find it more challenging to maintain their blood sugar levels.
- Gender – Male sex is a risk factor for asthma in pre-pubertal children. Female sex is a risk factor for the persistence of asthma in the transition from childhood to adulthood. Boys with asthma are more likely to grow out of their asthma during adolescence than girls.
- Housing and accommodation – There is evidence that children living in homes with damp or mould are 1.5-3 times more likely to experience coughing and wheezing. Exposure to high levels of house dust mite allergen in early life also increases the risks of subsequent asthma in young children. Asthma could, therefore, be more prevalent in more deprived areas, due to the poorer housing quality.
- Mental health – Psychological conditions such as anxiety and depression may be up to six times more common in people with asthma than in the general population (Department of Health, 2011).
- Obesity – Epidemiological data shows a link between asthma and obesity. This data has led researchers to suggest that obesity precedes asthma, increases both its prevalence and severity. The combination of diet and genes may alter the normal patterns of body growth (giving rise to obesity), the tone of the airways (giving rise to asthma), or both (Delgado, Barranco & Quirce, 2008).
- Cognition and self-efficacy – Patients achieving control of symptoms with treatment have a low risk of asthma attacks.
- Socio-economic factors – People from lower socio-economic groups are at higher risk, as are very young people and older people.
- Tobacco – the Department of Health 2012 states that there is evidence of exposure to tobacco contributes to the severity of childhood asthma. Average exposure is associated with a 30% increased risk of asthma symptoms. There is evidence of a direct causal relationship between parental smoking and lower respiratory tract illness in children up to 3 years of age.
Facts, figures and trends
The Outcomes Strategy for Chronic Obstructive Pulmonary Disease (COPD) and Asthma in England (Department of Health, 2011) states that the prevalence of asthma in England is among the highest in the world.
The Quality and Outcomes Framework (QoF) 2014/15 report states the prevalence of asthma in England is 3.4 million people, the rate having increased across all sub-regions in 2014-15 with the England level prevalence standing at 6.0% (0.1% above the previous period).
In 2013-14 there were more than 60,600 admissions to hospital where the main diagnosis was asthma, but in total asthma was part of the diagnosis in more than 1.3 million hospital cases. In 2014 there were 1,114 registered deaths with a primary cause of asthma in England and Wales.
Asthma is responsible for large numbers of attendances to emergency departments, and admissions, the majority of which are emergency admissions, and 70% of which may have been preventable with appropriate early interventions.
This short video on asthma and how to help manage the condition is fromthe council’s YouTube channel:
Hospital admissions
Emergency admissions for asthma in the Bracknell and Ascot CCG area in 2012/13 were 0.67% per 1,000 people (accessed 26 May 2016). This was significantly better than the national average (1.09%).
In 2012/13, the mean length of stay in hospital for emergency asthma admissions in Bracknell and Ascot CCG area was 3.17 days (accessed 26 May 2016). Between 2006 and 2011 the mean length of stay in hospital for emergency asthma admissions decreased from 3 days to 2.19 days. This increased slightly between 2011/12 and 2012/13 to 3.17 which was marginally higher than the 2012/13 England average (2.36 days).
Source: Interactive Health Atlas for Lung Conditions in England (INHALE)
The Outcomes Strategy for Chronic Obstructive Pulmonary Disease (COPD) and Asthma (Department of Health, 2011) sets out a number of recommendations to improve services for people with asthma:
- access to a service that facilitates prompt and accurate diagnosis, particularly the distinction between symptoms of asthma and chronic obstructive pulmonary disease in order to prevent misdiagnosis
- a focus on self-care and person-centred care planning that helps people understand their treatment monitor their symptoms
- a treatment plan agreed with the person with asthma which provides structured and ongoing support to avoid future occurrences and unscheduled healthcare
- stratifying GP practice populations of people with asthma according to their risk will enable practices to support the people most in need of proactive care
- a reduction in unnecessary bed days for a controllable condition will increaser the number available for patients with life threatening conditions
Costs
According to Asthma UK (accessed 26 May 2016):
- 5.4 million people in the UK are currently receiving treatment for asthma: 1.1 million children (1 in 11) and 4.3 million adults (1 in 12)
- Asthma prevalence is thought to have plateaued since the late 1990s, although the UK still has some of the highest rates in Europe and on average 3 people a day die from asthma
- 1,216 people died from asthma in 2014
- The NHS spends around 1 billion a year treating and caring for people with asthma
The estimated recorded prevalence of asthma in Bracknell Forest in 2014/15 was 5.6% which is better than the England average of 6.0%. This figure is the percentage of patients with asthma, excluding those who have been prescribed no asthma-related drugs in the previous twelve months, as recorded on practice disease registers.
In 2013-14 there were 850,634 hospital admissions for respiratory illnesses to English hospitals of which 60,636 had a primary diagnosis of asthma (comprising 53,033 emergency admissions).
Want to know more?
An Outcomes Strategy for People with Chronic Obstructive Pulmonary Disease (COPD) and Asthma in England (Department of Health, 2011) – the key document which sets out recommendations to improve services for people with asthma.
British Guideline to the Management of Asthma: a national clinical guideline (Healthcare Improvement Scotland, 2003, Revised 2014) – recommendations on management of asthma in adults, including pregnant women, adolescents, and children with asthma. Written for healthcare professionals, people with asthma, their parents/carers and those who interact with people with asthma outside of the NHS, such as teachers.
Designing and commissioning services for children and young people with asthma: A good practice guide (Primary Care Commissioning, 2013) – supports and extends the Department of Health Outcomes Strategy document with a support around the child approach within families, schools and health care settings.
Quality Standard for Asthma (NICE, 2013) – defines clinical best practice with specific, concise quality statements, measures and audience descriptors to provide the public, health and social care professionals, commissioners and service providers with definitions of high-quality care, and standards for diagnosis and treatment of asthma in adults, young people and children aged 12 months and older.
This page was created on 24 March 2014 and updated on 21 June 2106. Next review date January 2017.
Cite this page:
Bracknell Forest Council. (2016). JSNA – Asthma. Available at: jsna.bracknell-forest.gov.uk/living-working-well/health-conditions/asthma (Accessed: dd Mmmm yyyy)
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