Can someone clarify the asthma situation?

[Iremembertheelderlykoreanlady]

At first people with asthma were in group 6

Then they weren't

Now apparently people who use a brown preventer inhaler are back in group 6.

I used to use a brown inhaler but was using my blue one too much (asthma was not controlled) so they moved me to symbicort which is a combined inhaler.

So am I on the list for group 6 or not, as I don't use a brown inhaler anymore.

Does anyone know or could link to the guidance?

I wonder if the use of 'add on' treatments for asthma (long acting broncholidator/combined inhaler/LTRA tablets) means your asthma is difficult to control?

I take two add on treatments and everyone else I know with asthma doesn't take any - just the standard brown preventer and blue reliever.

If so, I wonder if those with difficult to control asthma will be offered the vaccine in group 6.

I think the vaccine issue started with DHSC telling Asthma UK back in December that asthmatics who weren't shielding and were aged 16 - 64 would be in group 6 when that wasn't aligned with the JCVI were planning. So a lot of us read Asthma UK's guidance last year and thought we were getting our vaccine in group 6 when it turns out not all of us are.

@AsthmaChecker

"Failure by JCVI to give clear definitions..."

To be fair, @myvaccineisnotsurplus - the JCVI has been very clear. They have specifically said that moderate and mild asthmatics (i.e. any asthmatic who is NOT shielding), will NOT be getting the jab in group 6.

OK - but there is a reason there are 8 pages of discussion here! It hasn't been that clear and any definition that is left at the GP's discretion fills me with dread.

@AsthmaChecker They have also said that anyone who gets an annual flu jab will be in Group 6 so very contradictory actually.

Also the criteria for receiving the flu jab refers to severe asthma but is classified as preventative inhaler, so there aren’t consistent definitions of what severe asthma means. I’ve seen articles in the press saying asthmatics will be in group 6 on the basis of Asthma UK’s previous statement too.

assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/907491/Flu_Vaccination_who_needs_it_and_why_12pp_A5_booklet_2020.pdf

I know asthmaUK are trying to do their best but I think they've caused much confusion now, and caused much confusion back at the beginning when shielding was first introduced.

I'm a GP with what I would consider to be moderate asthma (on high dose fostair and long term azithromycin antibiotics). Asthma UK had me as needing shielding for quite a while, though in fact I never was in that group.

Up until very recently we all thought group 6 was going to be 'flu jag' groups so I'm sure GPs will have been giving out mixed messages, which I'm sorry about

This is the current 'Green Book' guidance that is being followed:

Chronic respiratory disease

Individuals with a severe lung condition, including those with asthma that requires continuous or repeated use of systemic steroids or with previous exacerbations requiring hospital admission, and chronic obstructive pulmonary disease (COPD) including chronic bronchitis and emphysema; bronchiectasis, cystic fibrosis, interstitial lung fibrosis, pneumoconiosis and bronchopulmonary dysplasia (BPD).

So my understanding is 'repeated or frequent courses of systemic steroids'- (means oral or intravenous, not inhaled of any strength)- or previous hospital admissions- not sure if there is a cut off on dates on that.

The good news is that Covid really doesn't seem to affect asthmatics as badly as you would think it does. The risk factors for severe disease are very much age, obesity, black or south asian ethnicity, heart disease, vascular disease, kidney disease etc. I reduced my exposure at work during the first wave (eg didn't do home visits) but by the time the second wave came the evidence for asthma was relatively reassuring.

For those of you confused about inhalers, ALL asthmatics on a preventer inhaler (ie taken daily) will be on a steroid inhaler, either on its own or mixed with a long acting bronchodilator. There a no steroid-free preventer regimes for asthma (unlike COPD).

Sorry its a very long post, but GPs are trying to keep up as much as the rest of you- and often don't have the information much sooner than it's made public. We also don't have flexibility on the groupings- the data is extracted centrally and the lists made up centrally. We can only add in if someone has been genuinely missed, not change peoples' groups against the guidelines.

Thanks for the clarification. It sounds like my Gp mate was under the same impression originally.

@Seoirnbru is ethnicity being taken into consideration when deciding priority groups since it’s a risk factor?

@Bluebelle41 not as far as I can see, no (unless they have another condition eg Type 2 diabetes). It is, however, now being taken into consideration for NHS staff risk assessments locally at least.

@Seoirnbru is that the the guidance for group 4 or group 6?

My GP has said I’ll be in group 6. I’m on Fostair, Ventolin, Montelukast and have had four courses of pred this year, in case that helps anyone.

My reading of it is that covers both group 4 and 6- they've kind of lumped them together in the guidance- group 4 if you have shielding letter and group 6 if you don't.
The full guidance is here: assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/955548/Greenbook_chapter_14a_v6.pdf

There are definitely patients in this full list that aren't shielding eg Chronic Kidney disease stage 3 or diabetes- so I think it must follow the known risk factors for severe disease (other than ethnicity).

@Papyrus- it's the four courses of prednisolone (systemic steroids) that puts you in group 6, not your inhalers or montelukast.

@Seoirnbru doesn't that also put you in group 4? That's what makes no sense. I can't work out who would be in group 6 but not group 4.

I'm struggling with it as well to be honest!
Group 4 is if you've got a shielding letter.
Yes, you should be in shielding group if you'd had enough courses of steroids to count. But they were originally picked up when the searches were first run (? April- feels so long ago now I've forgotten!) -there will be people who've had steroids since who would now fit that group but won't necessarily have received shielding letters. Likewise some will have 'fallen out' of shielding category if they've now NOT had any steroids for a year.
And 'hospital admissions with asthma' as a criteria wasn't in the original shielding criteria either as far as I remember.
Clear as mud? Feels like it to me too!

Thanks for commenting on the thread. I do think it’s silly to drop people from shielding based on medication over the past year. If they have been shielding they have probably avoided many of their asthma triggers. This goes for non-shielding people with asthma as well.

I understand that there needs to be a cutoff somewhere but it won’t be reassuring to everyone. What if someone has “moderate” asthma, is pre-diabetic, and whose ethnicity puts them at higher risk? They will be exposed after lockdown ends and still be at a higher risk than others in their age group.

@Bluebelle41 I actually totally agree. It would certainly make our (GPs) lives much easier if they'd stuck to the flu jag group. I'm on leave this week (which is why I'm faffing around on here and ignoring the million and one housey jobs on my list) but I'd imagine our phones have been ringing off the hook.

As everyone else said really, super disappointing.

I am not a Dr, but my understanding is that they have erred on the side of inclusion for other at risk groups (albeit sometimes after pressure) not sure if anyone else has any input on that, or if we can take that as a guideline?

It's pretty rubbish if asthmatics dont get vaccinated because
normally Higher risk of hospitalisation for asthma attack
My gp didnt consider me to have asthma at all ! As i wasnt on a preventer. Except i manage with ventolin when ill. I never run anywhere. And avoid triggers, cats, smoke etc.
Anyway i then got ill in apr. Couldnt breathe. Had to sleep on stomach. I would have gone to hospital if that happened pre covid i felt so bad but also they werent taking anyone not blue.
It then took till jul for the rib pain and in my upper back to go. I started on preventer meds and did feel a bit better.
Now whether it was because of my asthma? I dont know i also have pcos and thyroid issues. So obviously high blood sugar. I wasnt wheezy ever though like a normal cold which is caused by phlegm.
Im early 40s.
Im not overweight though.

Also what they arent considering is adding extra lung damage onto already having problems breathing isnt great.

The shielding advice I remember was either (it was changed)

Four or more courses of oral steroids
Steroid inhaler plus oral medication (ie monteleukast)
OR
Any Critical Care Admission

(at least this is what my GP used - I had all three)

The steroid inhaler plus oral medication was on the original asthma uk list but never made it to the official shielding list (as I would have been on it but am not).

I was on the original shielding list and have never been removed, despite not meeting the steroid criteria. Had my vaccine as group 4 two weeks ago. It's not very consistent at all.

@Seoirnbru I think that was the second list I posted (I remember they dropped it from ITU admission in last year to ITU admission at any time). It was by Asthma UK or the Lung Charity (name escapes me).

I know when they changed it it must have added several thousands more people to the shielding category.

Agree with a lack of consistency though.

So it sounds like most asthmatics won't be on the list? I take seretide (purple inhaler) daily and salbutamol when needed, and I'm in my 40s if that makes a difference.

Does that mean that we are no longer classed as vulnerable? I haven't been shielding but I've been taking extra precautions due to being asthmatic including turning down work that would involve being face to face with the public.

I'd be disappointed to hear that I won't be getting a vaccine any time soon, but happy if that means that I am now considered low risk.

Asthma UK posted this on Twitter this morning.

Is this the "clarification" they were hoping to provide this week?

Fucking ridiculous.

@Peakedin1997 that would be the obvious conclusion. Whether there is an peer reviewed research on it is a different matter. I am worried asthmatics are underrepresented in the death figures because many in the CV category have chosen to shield (or close to it)