Lancashire Teaching Hospitals NHS Foundation Trust

4. Mrs X complains her mother, Mrs P, did not receive any salbutamol medication until 2 days before her death in January 2023.

5. Mrs X said her mother had been taking salbutamol medication all her life and she believes that the above failing resulted in her mother’s death.

6. Mrs X is seeking acknowledgement of failings, an apology and a financial remedy.

7. Mrs P had a history of chronic obstructive pulmonary disease (COPD is the name for a group of lung conditions that cause breathing difficulties), high blood pressure and chronic kidney disease (a long term condition).

8. Mrs P was admitted to hospital on 10 January 2023 following a stroke. She underwent a thrombectomy (procedure to remove a blood clot from the brain) and was transferred to the acute stroke ward. She required oxygen support until 11 January. On 14 January, the Trust transferred Mrs P to another hospital which it manages.

9. A consultant in elderly medicine saw P on 16 January. The consultant noted she had swallowing problems due to her stroke and she was referred to the speech and language therapy team. The medical team inserted a nasogastric tube for feeding and medications. An X-ray showed she had developed pneumonia and she was prescribed antibiotics.

10. Mrs P tested positive for COVID-19 on 19 January and she was placed in isolation.

11. A doctor put a do not attempt cardiopulmonary resuscitation order in place following discussions with the family. Mrs P was suffering with fatigue due to her stroke, pneumonia, COVID-19 and frailty.

12. Mrs P was reviewed and given salbutamol nebulisers for wheeze on 28 January. However, Mrs P sadly died the following day. The cause of death was recorded as Ia Pneumonia Ib Stroke II Covid-19, Frailty and COPD.

Failure to give Mrs P her salbutamol medication

16. Before we decide if we should conduct a detailed investigation of a complaint, we look at whether there are signs the Trust has got something wrong. We do this by comparing what should have happened with what did happen. We have done this and have not found any indications that something has gone wrong.

17. Mrs X complains that her mother who had been on salbutamol "all her life" did not receive any of this medication until two days before she died. She considers this was the cause of her mother's death.

18. The Trust says Mrs P’s death was due to the pneumonia, stroke and frailty and not because she did not receive salbutamol for her asthma/COPD.

19. Our adviser explained that salbutamol is a type of drug known as a short acting beta-agonist (SABA). There are also longer acting beta-agonists (LABA) such as formoterol. All of these drugs stimulate receptors in the lungs to help the airways relax. This helps patients with asthma to breathe more easily.

20. Mrs X correctly noted her mother did not consistently receive salbutamol. Our acute medicine adviser said there is a reasonable explanation for this in that it may have been due to new fast atrial fibrillation (irregular heart rhythm) and low potassium. Our acute medicine adviser said salbutamol can further reduce potassium which can make atrial fibrillation more resistant to treatment. However, we cannot see from the records if that was reason the salbutamol was not given to her.

21. That said, our acute medicine adviser told us Mrs P did receive appropriate medication for control of her asthma. Her prescription included inhaled steroid (budesonide) and a long acting beta-agonist (formoterol) in a combined form inhaled twice a day. They said this combination offers a higher level of care compared to short acting beta-agonists such as salbutamol. This treatment is recommended in line with the NICE and British thoracic Society guidelines - BTS/NICE/SIGN Joint Guideline on Chronic Asthma. Our acute medicine adviser said this guidance was published after the events giving rise to this complaint but the evidence regarding this treatment was available at the time of Mrs P’s treatment.

22. Our acute medicine adviser further explained Mrs P also had Ipratropium prescribed which is appropriate for COPD. Ipratropium belongs to a class of drugs which help to open the airways in the lungs, making breathing easier.

23. The indications are that whilst Mrs P did have diagnoses of both asthma and COPD she received treatment for these which was appropriate. Our acute medicine adviser said the omission of salbutamol did not cause Mrs P’s death.

24. Having taken into account the available evidence and our acute medicine adviser’s advice there are no indications of failings on the part of the Trust. It is for this reason that we consider we do not need to take any further action. We recognise the importance of this matter to Mrs X and her father and we hope we have clearly explained the reasons for our decision.

1. We have carefully considered Mrs X’s complaint Lancashire Teaching Hospitals NHS Foundation Trust. We have seen no indication that anything went wrong.

2. Having considered the available evidence there is no indication of failings regarding Mrs P’s salbutamol medication.

3. We recognise the impact that Mrs P’s death has had on Mrs X and her father and we are sorry about that. We have set out the reasons for our decision below.