1.1 million of the UK’s children have asthma. 10% have moderate-to-severe asthma and these children should be treated by specialist paediatricians, expert in controlling what can be a life-threatening condition.
Widely reported in the media on 30th October 2019 (BBC, Daily Mail, Telegraph) is the negative environmental impact of using the most commonly prescribed type of inhaler in which the life-saving medication is inhaled by the patient propelled by a gas¹,².
The NHS Long-Term Plan published by the NHS and the UK’s National Institute for Health and Care Excellence (NICE) calls for prescriptions to be changed to a different type of inhaler that delivers the same medication as a fine powder, which can be used by most adults with asthma. Much has been made of the reduction in emissions of greenhouse gases this could achieve and that adult patients should be able to make an informed choice about which medication they use.
But young children are unable to use dry powder inhalers. We are concerned that the over-emphasis of environmental messages delivered to children, however unintended, will add yet another pressure to parents and teachers, in the management of severe asthma in children. Manufacturers of gas-propelled inhalers could also help by accelerating their transition to the use of non-greenhouse propellants.
Children with severe asthma are already disadvantaged in their school career in which they can feel different and isolated from their peers. Some may be less able to play sports. They have to carry reliever inhalers (or have them immediately available) during playtime or on school trips and can miss vital education to attend outpatient clinics, in addition to missed education through ill health.
Now there is the extra burden of being made to feel responsible for damaging the environment because they use their inhalers regularly – as prescribed and as needed – to successfully manage their asthma.
Policy makers, the NHS and the media therefore need to be particularly sensitive about how they promote the transition to dry powder inhalers for adult care on environmental grounds, because most young children cannot use them.
The original publication by the House of Commons Environmental Audit Committee noted: “There was a consensus that [dry powder inhalers] may not be appropriate for certain groups, such as the elderly and the very young.” But this vital statement was lost in the discussion about greenhouse gas emission reduction and which was compared with a few car journeys or becoming a vegetarian2.
The House of Commons Environmental Audit Committee publication rightly recommends that “low Global Warming Products [dry powder] inhalers should be promoted within the NHS unless there are specific medical reasons for not doing so.”
But we urge that the use of these messages are managed more carefully. It must also be explicitly stated that “most young children and some older people are unable to use these and should use metered dose type inhalers as prescribed by their doctors, and these are highly vulnerable patient groups. A day spent in hospital or a trip in an ambulance to A&E because of an asthma attack, generates more pollution and greater costs to the NHS than using an inhaler.”
Great care should also be taken to avoid using images of children using inhalers in publication of reports of this nature in the media, especially when there is a link to environmental issues, to avoid stigmatising children with asthma as polluters. We should not give the message, however unintended, that children with asthma are polluting the environment when they and their family are successfully managing this life-threatening condition.
References:
[1] House of Commons Environmental Audit Committee UK Progress on reducing F-gas Emissions. Fifth Report of Session 2017–19. Report, together with formal minutes relating to the report Ordered by the House of Commons to be printed 18 April 2018. HC 469 Published on 25 April 2018 by authority of the House of Commons.
[2] Wilkinson, AJK et al. The costs of switching to low global-warming potential inhalers. An economic and carbon footprint analysis of NHS prescription data in England. BMJ Open; 30 Oct 2019; DOI: bmjopen-2018-028763.
Notes to the Editor:
Key Facts About Paediatric Asthma
• 1.1 million children in the UK receive treatment for asthma
• 24,744 emergency admissions for asthma in 2012
• 20 children under 14 years died from asthma in 2018 in the UK
• There were preventable factors in 90% of childhood deaths from asthma
• Less than 25% of the child that died from asthma had a Personalised Asthma Action Plan (PAAP)
• Nearly half of the children that died had an asthma attack in the previous year
• 30% of the children had daytime symptoms in the previous week
• It is the most frequent reason for emergency admission to hospital
• The UK has the third highest risk of death from childhood asthma in OECD nations (Asthma UK)
• 10% of children with asthma have what is clinically defined as moderate-to-severe or difficult-to-treat asthma and should be treated in specialist paediatric clinics (Asthma UK)
Aseptika’s innovation Asthma⁺me is specifically designed to support children with moderate-to-severe asthma from the age of 6-12 years.
The Asthma⁺me solution is a comprehensive CE-marked self-care solution, co-designed with a specialist NHS Children’s Hospital, which includes: education sessions, PUFFClicker smart pMDI inhaler-use tracking, tracks doses from dry powder inhalers, lung-function monitoring, in-built symptom checkers, online educational syllabus for child/family, electronic care plan and ability to push data to hospital/GP electronic patient records.
Healthcare specialists are actively searching to reduce the over-use of Out-Patient appointments and to address the unmet need to support this group of patients. NHS Commissioners are actively seeking technology innovations to support this and supported by policy in the NHS Long-Term Plan.
A further Clinical Trial is being conducted to further develop the Asthma⁺me to add the Activ8rlives’ neural networks (Artificial Intelligence). This will help to predict and warn of an asthma attack, making it smarter using the AI to recognise signs of impending asthma attack. Acting quickly and knowing how to prevent asthma symptoms progressing into full attack can make all the difference.
Our approach enables children and parents/carers to self-care and reduce the use of NHS services across the ecosystem but remain connected to expert support at the paediatric clinics.
V1.0 Final