Asthma UK supports people with asthma
when they need us the most and funds
world-leading research to find better
treatments and ultimately a cure.
Asthma UK Helpline
0800 121 62 44
Asthma UK
18 Mansell Street
London E1 8AA
T 020 7786 4949
www.asthma.org.uk
Under embargo: 00.01am BST Tuesday 16th June 2015
Press release
Tens of thousands at risk of potentially life threatening
asthma attacks from unsafe prescribing
Last year’s National Review of Asthma Deaths1 highlighted prescribing errors in nearly half
of asthma deaths in primary care (47%). Now new analysis from Asthma UK, based on data
from over 500 UK GP practices2, reveals evidence that over 22,000 people with asthma in
the UK, including 2,000 children, have been prescribed medicines (long-acting reliever
inhalers) in a way that is so unsafe they have a ‘black box warning’ in the USA due to the
risk they pose to the lives of people with asthma3. In addition, the report indicates that
almost 100,000 people with asthma have been prescribed too many short-acting reliever
inhalers (more than 12 in a year) without national clinical guidelines being followed4,
leaving them at risk of life threatening asthma attacks.
Asthma medication is safe, but it is dangerous to use a long-acting reliever inhaler alone
(without a steroid preventer inhaler or as a combination inhaler). This is because a longacting reliever inhaler helps to keep the airways open but does not treat the underlying
inflammation. This leaves the airways of people with asthma inflamed and more likely to
react to triggers such as pollen or pollution, putting them at risk of having a potentially
life-threatening asthma attack. If someone with asthma is prescribed more than 12 short
acting reliever inhalers in a year (using it more than 3 times each week) without seeing a
doctor it is a key indicator that they are not managing their condition and that their
treatment needs reviewing.
Kay Boycott, Chief Executive of Asthma UK, says: “It is simply unacceptable that the lives
of people with asthma are being put at risk because of unsafe prescribing. The UK has
some of the highest mortality rates for asthma in Western Europe and the levels of unsafe
prescribing identified in our report today must be stopped. It is crucial that healthcare
professionals review their systems and urgently recall patients who have been prescribed
long-acting reliever inhalers on their own without a steroid preventer, or not as a
combination inhaler. NHS bodies must ensure systems are in place to stop unsafe asthma
Asthma UK is a company limited by guarantee. Registered in England number 2422401. Registered charity number 802364
Asthma UK supports people with asthma
when they need us the most and funds
world-leading research to find better
treatments and ultimately a cure.
Asthma UK Helpline
0800 121 62 44
Asthma UK
18 Mansell Street
London E1 8AA
T 020 7786 4949
www.asthma.org.uk
prescribing from happening and implement all the recommendations from the National
Review of Asthma Deaths to improve patient safety and end complacency in asthma care.”
Ms Boycott adds: “Anyone with asthma who is concerned by these findings should try not to
worry – they are not in any immediate danger. However, it is important that people with
asthma really understand their medicines and take an active role in managing their
medication. They should check if their inhaler includes Salmeterol, Formoterol or
Tiotropium bromide as the only active ingredient and if so book an appointment with their
GP or asthma nurse. Anyone who is using their reliever inhaler more than 3 times a week
and hasn’t had a recent review should also contact their practice. If people are not sure if
this applies to them, they should visit the Asthma UK website for more information or call
the Asthma UK Helpline for advice and support on 0800 121 62 44.”
Dr Mark Levy, GP and author of The National Review of Asthma Deaths, says: “Asthma UK’s
report is welcome as it echoes the findings from the National Review of Asthma Deaths.
There is widespread failure to recognise risk of attacks and therefore asthma death. Yet
the reality is that deaths can be prevented when symptoms are managed effectively, with
safe use of asthma medicines and in partnership with the patient.”
Asthma UK Checklist
Don’t stop taking your medication – you are not at immediate risk. These simple steps
will help you to actively manage your medicines
Am I taking medication with a ‘black box’ warning in the USA?

The first thing to do is to check if you are using an inhaler which has Salmeterol,
Formoterol or Tiotropium bromide as the only active ingredient. If you are taking
this without a steroid preventer inhaler then you need to contact your GP right
away. If you are not sure if this is you, then visit the Asthma UK website for more
information about inhalers and health advice about managing your medicines
www.asthma.org.uk

If you cannot book an appointment right away with your GP, you can also call the
Asthma UK Helpline on 0800 121 62 44 for advice and support (Monday to Friday
9am until 5pm).
Asthma UK is a company limited by guarantee. Registered in England number 2422401. Registered charity number 802364
Asthma UK supports people with asthma
when they need us the most and funds
world-leading research to find better
treatments and ultimately a cure.
Asthma UK Helpline
0800 121 62 44
Asthma UK
18 Mansell Street
London E1 8AA
T 020 7786 4949
www.asthma.org.uk
Taking more than 12 reliever inhalers a year?

If you are using your reliever inhaler (often a blue colour) more than 3 times a week
(using more than 1 inhaler a month) it’s a sign your asthma is not well controlled. If
this is you, book an asthma review with your GP as soon as possible.

If you cannot book an appointment right away, visit the Asthma UK website for
more information www.asthma.org.uk.

You can also call the Asthma UK Helpline nurses on 0800 121 62 44 for advice and
support (Monday to Friday 9am until 5pm).
ENDS
Notes to editors
Data sources
1. https://www.rcplondon.ac.uk/sites/default/files/why-asthma-still-kills-full-report.pdf. A
list of avoidable factors. Note: Avoidable factors relating to prescribing were identified by
the panels in 47% of the cases managed in primary care. P. 60, section 8
2. The report findings are based on data from the Optimum Patient Care Research Database,
which was analysed by Asthma UK, in collaboration with Optimum Patient Care Ltd and the
Respiratory Effectiveness Group, and published in 2015: Lewis C., Humphreys E., Chisholm
A., Carter V. & Price D. (2015) Evidence of poor prescribing in asthma care. Respiratory
Effectiveness Group Asia-Pacific summit, Singapore. Data extracted during 2010-2013,
sample size of 94,955, sourced from GP Practice systems in England (456), Scotland (54),
Wales (5) and Northern Ireland (5). Total number of incidents are estimated by calculating
the relevant sample percentage for adults, children and all and applying this to the
corresponding asthma populations in the UK. The OPCRD is a quality controlled, voluntary
GP Practice database and can therefore not be guaranteed to be representative of the UK
population. http://www.optimumpatientcare.org/OPCRD.html
3. What is a black-box warning? Black-box warnings take their name from the black border
around the information and are The Food and Drug Administration (FDA’s) most stringent
warning a drug can carry before it is pulled from the shelves
http://www.fda.gov/drugs/resourcesforyou/consumers/ucm072025.htm
4. Prescribed without a healthcare professional reviewing their condition and assessing why
their asthma control is poor. This is a sign that someone with asthma is over-relying on their
short-acting reliever inhaler and not staying on top of their condition https://www.britthoracic.org.uk/guidelines-and-quality-standards/asthma-guideline/
Where do I go for advice and information
 People with asthma should visit http://www.asthma.org.uk/inhaler-safety
 Healthcare professionals including CCGs should visit http://www.asthma.org.uk/prescribing-
safety

National policy-makers should visit http://www.asthma.org.uk/patient-safety
Asthma UK is a company limited by guarantee. Registered in England number 2422401. Registered charity number 802364
Asthma UK supports people with asthma
when they need us the most and funds
world-leading research to find better
treatments and ultimately a cure.
Asthma UK Helpline
0800 121 62 44
Asthma UK
18 Mansell Street
London E1 8AA
T 020 7786 4949
www.asthma.org.uk
What are long-acting reliever inhalers?
The long acting reliever inhalers include:
 Serevent Evohaler (Salmeterol), Serevent Accuhaler (Salmeterol), Vertine Metered-Dose
Inhaler (Salmeterol), Formoterol Easyhaler (Formoterol), Oxis Turbohaler (Formoterol),
Foradil Dry Powder Inhaler (Formoterol), Atimos Modulite Metered-Dose Inhaler
(Formoterol), Spiriva Respimat (Tiotropium)
 Long-acting reliever inhalers keep your airways opened up by relaxing the muscles around
them. This helps you breathe more easily. Long-acting muscarinic receptor antagonist
(LAMA) inhalers have also been shown to reduce the amount of mucus produced in your
airways.
 It is dangerous to use a long-acting reliever inhaler without a steroid preventer inhaler. This
is because a long-acting reliever inhaler helps to keep your airways open, but doesn’t treat
the underlying inflammation in your airways. The inflammation makes your airways more
sensitive and irritable. Without using a steroid preventer inhaler alongside a long-acting
reliever inhaler, this underlying inflammation will just get worse and worse. This means
your airways are more sensitive to your asthma triggers, and more likely to react to them,
putting you at an increased risk of an asthma attack.
What are the short-acting reliever inhalers?
The short acting reliever inhalers include:
 Ventolin Evohaler (Salbutamol), Ventolin Metered-Dose Inhaler (Salbutamol), Ventolin
Accuhaler (Salbutamol), Pulvinal Salbutamol (Salbutamol), Easyhaler Salbutamol
(Salbutamol) , Airomir Metered-Dose Inhaler (Salbutamol), Airomir Autohaler (Salbutamol),
Salamol Metered-Dose Inhaler (Salbutamol), Salamol Easi-Breathe (Salbutamol), Salbulin
Novolizer (Salbutamol), Bricanyl Turbohaler (Turbutaline)
About Asthma UK
 Asthma UK’s mission is to stop asthma attacks and cure asthma. We do this by funding world
leading research, campaigning for improved care and supporting people to reduce their risk
of a potentially life threatening asthma attack
 Asthma UK is solely funded by public donations
 The Asthma UK Helpline is open weekdays from 9am to 5pm on 0800 121 62 44.
 For more information about asthma please visit www.asthma.org.uk
Background information on asthma
 In the UK, 5.4 million people are currently receiving treatment for asthma: 1.1 million
children (1 in 11) and 4.3 million adults (1 in 12).
 The UK has amongst the highest prevalence rates for asthma in Europe, according to the
European Community Respiratory Health Survey.
 The UK currently has some of the worst asthma mortality rates in Western Europe.
According to the Death rates (all ages) for OECD nations the UK rate for 2010 was 1.6 per
100,000 of population, after Estonia (3.1) and Spain (1.8)
 Three people die every day because of asthma; based on mortality data from Office for
National Statistics (ONS) for England & Wales, General Register Office for Scotland, and
Northern Ireland Statistics & Research Agency (Northern Ireland). 1255 people died from
asthma in 2013 – divided by 365, this works out as 3.4 people per day.
 Tragically, the National Review of Asthma Deaths found that two thirds of asthma deaths
are preventable with good, basic care.
 Research by Asthma UK shows that 8 out of 10 people with asthma do not receive care that
meets the most basic clinical standards. For more information visit http://www.asthma.org.uk/takeaction
Asthma UK is a company limited by guarantee. Registered in England number 2422401. Registered charity number 802364