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  1. Andrew Bush,
  2. Ian Pavord

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NRAD: No more regular asthma deaths

The Hot off the Breath on the National Review of Asthma Deaths (NRAD) made depressing reading for your editors, who are well old enough to have seen it all before (see page 209). In all age groups NRAD identified fundamental errors in risk assessment, dangerous over-prescribing of reliever inhalers, the absence of regular review, and lack of engagement in personalised asthma action plans (PAAP). Winter and Levy make the excellent suggestion that computerised prescribing systems could be configured to provide an alert when relievers are over-prescribed. Otherwise their recommendations are much the same as those made as far back as 1974. KISS (Keep It Simple, Stupid) is good, but should we not also fundamentally rethink how asthma is assessed and managed? Would risk stratification help? Exhaled nitric oxide (FeNO) and blood eosinophil count are more strongly associated with the risk of severe asthma attacks in adults and likely benefit of regular inhaled corticosteroids than traditional assessments. Might targeting a high risk, high benefit group help sceptical patients engage long-term with their brown inhaler and PAAP? Would primary care perform tests …

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