Asthma. Why do doctors not follow official guidelines on treating this condition?

Some time ago NICE (the UK's National Institute for Health and Clinical Excellence) recommended that doctors stepped down the use of asthma drugs in what they described as 'stable patients'. This was sensible advice given. They said, quite clearly, that there was no benefit in giving more drugs, more inhalers, as they could cause serious adverse effects; and reducing them would save the NHS money.

However, MIMS has now reported (July 2020) on new research that has shown this is not happening in practice - despite all the benefits of greater patient safety, and cost.

Instead, patients with asthma are increasingly being prescribed 'higher-level' treatment, often without clear clinical need, and a large proportion never have their medication stepped down - despite the clinical and cost benefits of doing so. These are the findings of UK research undertaken between 2001 and 2017. As MIMS reports:

               "They found that prescriptions of higher-level medication, such as medium- or high-dose inhaled corticosteroids, or inhaled corticosteroids with add-on medication such as long-acting ß2-agonists (LABAs), increased from 49.8% in 2001 to 68.3% in 2017. Among patients prescribed their first preventer, one third were prescribed a higher-level medication. Half of these had no reliever prescription or asthma exacerbation in the preceding year, suggesting the prescribers were not following clinical guidelines. Of the patients first prescribed inhaled corticosteroids with one add-on treatment, the majority (70.4%) remained on the same medication during a mean follow-up of 6.6 years."

What is worse the research found that 1 in 8 patients (13%) who were prescribed medium or high dose inhalers already had conditions that could be worsened by corticosteroids, such as diabetes, glaucoma or osteoporosis. So is this gross negligence by doctors?

Conventional medicine is allowed to peddle pharmaceutical drugs and vaccines that have serious adverse effects, that can cause serious patient harm, chronic disease, and death. And it might be expected, this being so, that doctors would take great care to follow the official guidelines on their prescription.

Yet unfortunately for patients (those who continue to place their trust in pharmaceutical medicine) this is often not the case. And it is so not just in this case of these asthma guidelines. In the same edition of MIMS, they reported that doctors should not prescribe analgesics for chronic pain.

Doctors will also ignore this guidance. How do I know? Doctors have nothing else to prescribe! They may be aware that paracetamol, ibuprofen, other NSAID painkillers, benzodiazepines and opioids should not be offered to people with chronic primary pain "because there is little evidence that they made any different to people's quality of life, pain, or psychological distress"; but when they are faced with a patient in chronic pain they will almost certainly continue to prescribe them. They will find it hard to tell a patient in pain that there is nothing they can do, nothing they can offer. So take the painkillers, and when they don't work, when they make the pain worse, come back and see me again. At least it gives the doctor a few week's grace. They have done something!

This is where conventional medicine now finds itself. The drug cupboard is bare. Doctors can prescribe few drugs (if any) that are safe. Or few drugs that make any significant difference to patients who are sick. And this applies to all illnesses. We are witnessing the failure of conventional medicine.

So rather than admit failure, doctors continue to prescribe the same old failed and harmful pharmaceutical drugs.

NICE will continue to provide guidelines for doctors about the drugs they cannot prescribe, albeit belatedly for the patients who have already been harmed by them. But they cannot tell doctors what they should be doing instead - because they have no alternative.

Steroid Inhalers. Not as good as we were told, and more harmful to our health

Many people use inhalers, and have done for decades. Now it has been discovered they are not as good as we have been told, and they are more harmful to our health too. New NICE guidelines have been issued, asking doctors to start reviewing all COPD patients, and consider taking those using inhaled steroids off their inhalers. It is thought that this could involve at least 500,000 patients.

               "It comes amid mounting evidence that steroids are less effective in COPD than previously thought and also more harmful – in particular by increasing the risk of pneumonia, as well as other side-effects such as worsening diabetes and reduced bone density."

The GP's magazine in Britain, Pulse, from which this quote is taken, say that new international guidelines are advising greater caution with the use of steroid inhalers following publication of "a raft of new studies". Experts in respiratory medicine are calling for an overhaul of the management of patients with COPD in primary care.

Yet this is a process to which the conventional medical establishment has subjected us too now for a very long time.

• New treatments are introduced, heralded as wonder cures for this or that ailment, with its benefits greatly exaggerated, and its side effects greatly underestimated.
• Millions of people are placed on the treatment in the belief that it is helpful, and that they are safe taking it.
• The Pharmaceutical Industry makes enormous profits.
• Decades later 'medical science' discovers that it got it wrong, the treatment is not a wonder cure, and the harm it does was far greater than they had previously thought.
• There is a grudging, but partial recognition that patients have  been, and are being harmed, that the health of many may have been compromised.

Doctors are already overworked. The NHS is already in crisis because of the demands made upon it by sick patients. Many more of these demands, it would seem, are the result of inhalers! One recent study (Price D, et al. First maintenance therapy for COPD in the UK between 2009 and 2012: a retrospective database analysis. NPJ Prim Care Respir Med 2016; online 3 Nov. tinyurl.com/hagdzev) has apparently showed more than half of patients with COPD were started on an ICS inhaler and, as many more will have therapy stepped up. Now most of them could probably be taken off steroid therapy completely. The medication they have been taking, sometimes for decades, are no longer considered to be safe!

So how many patients have suffered pneumonia, worsening diabetes, and reduced bone density because of the inhalers prescribed to them as effective and safe?

Pulse does not say. Perhaps no-one knows. Perhaps no-one want us to know! Yet Pulse states that a recent study highlighted that large numbers of patients, with mild or moderate COPD, end up on triple therapy - with two long-acting bronchodilators and an ICS. This, the new guidelines state, is treatment that should be reserved for those with the most severe disease.

Consider this for a moment, and then ask what sort of medical system it is that has dominating health care for the last 100 years!

• Patients with mild or moderate COPD have been over-drugged with inhalers that are less effective and more harmful than previously realised, and as a result many patients have suffered from pneumonia, worsening diabetes, and reduced bone density as a direct result.
• In future, it will only be the sickest patients who will have this level of treatment because it is no known that it has too many harmful side effects, it is just too dangerous for anyone else! In other words, the sickest are getting the most dangerous treatment!

No wonder the NHS is in crisis. As I have said many times before pharmaceutical drugs and vaccines are not making us better, they are the cause of increased levels of sickness and disease.

Yet there is a further problem for the conventional medical establishment. Their medicine cupboard has just become a little bit barer!

• Antibiotics are failing, coming to the end of their useful life.
• Painkillers have so many serious side effects they should only be used with the greatest caution
• Psychiatric drugs are so dangerous to our health that doctors have to use 'talking therapies' instead.

Now doctors are losing their inhalers. So what do they have to replace them? The Pulse article provides us with the answer

               "One barrier to stepping down therapy is that it is often started because of a lack of alternatives. Dr Gruffydd-Jones adds: ‘Pulmonary rehabilitation has not been freely available in a timely manner. Waiting lists can be several months, so as a GP what are you going to do? You feel you have got to try something and end up escalating the treatment.’"

So this is yet another very serious problem for the conventional medical establishment. They have been prescribing dangerous and ineffective drugs for a long time. As a nation they have made us sicker. They are running out of money. They are running out of drugs. And they are running out of time!

References given in the Pulse article.

GOLD, 2017. Global Strategy for the Diagnosis, Management and Prevention of COPD. tinyurl.com/gu85rmb

NICE CG101. COPD in over-16s: diagnosis and management, 2010. tinyurl.com/NICE-CG101

Price D et al. First maintenance therapy for COPD in the UK between 2009 and 2012: a retrospective database analysis. NPJ Prim Care Respir Med 2016; online 3 Nov. tinyurl.com/hagdzev

Haughney J et al. The distribution of COPD in UK general practice using the new GOLD classification. Eur Respir J 2014;43:993–1002. tinyurl.com/zfg2eou

Royal College of Physicians, 2016. National COPD Audit Programme: primary care work stream. tinyurl.com/haqml5z

White P et al. Overtreatment of COPD with inhaled corticosteroids. Implications for safety and costs: cross-sectional observational study. PLoS ONE 8: e75221. tinyurl.com/z4rcrbk

Mak V and D’Ancona G. Avoiding inappropriate prescribing of high dose inhaled corticosteroid combination inhalers – is the message getting through? Thorax 2016;71 (Suppl 3):A118-A119. tinyurl.com/Thorax-ICS