Risks of poor asthma outcome in 14,405 children and young people in London

Mark L Levy

doi:10.1038/s41533-020-00215-7

Abstract

This is a 12-month retrospective data analysis (2018/19) of asthma risk factors in 350 North West London general practices. Fourteen thousand four hundred and five of the 482,029 (40% female) children and young people (CYP) had diagnosed asthma. Exacerbations are as follows: (i) 749 (5%) CYP had 797 hospital admissions; 32 (<1%) had 2–6; (ii) 910 (6%) had 1168 recorded asthma attacks; 170 (1%) had 2–12; (iii) 1485 (10%) had 2123 oral corticosteroid courses; 408 (3%) had 2–11. Excess short-acting bronchodilators were prescribed in over half of the CYP. Of the 10,077 (70%) CYP prescribed inhaled corticosteroid preventers, 7279 (72%) were issued with <4 ICS inhaler prescriptions during the year; these CYP accounted for 11% of the admission spells. In all, 30% of CYP had poor symptom control. At least 10% of the CYP having had recent attacks are at risk and dashboards such as those available in North West London could easily facilitate recognition of risk and optimisation of care.

Highlights

The United Kingdom (UK) National Review of Asthma Deaths (NRAD) (2011–2014)[1] identified a number of potentially preventable risk factors in those who died, many of which had been recognised previously[2,3]
The results identified a wide variation in process of care and presence of risk factors, including excess short-acting bronchodilator reliever (short-acting beta-2-agonist (SABA) bronchodilators) and insufficient inhaled corticosteroid (ICS) controller prescriptions, failure to issue personal asthma action plans (PAAPs) or to perform annual reviews or to check inhaler technique
This study aimed to investigate the current prevalence in National Health Service (NHS) general practices (GPs) of known risk factors for poor asthma outcome in children and young people (CYP) with doctor-diagnosed asthma meeting Quality Outcomes Framework (QOF) criteria above in the 12 months from April 2018, utilising the WSIC data in North West London (NWL)

Summary

Introduction

The United Kingdom (UK) National Review of Asthma Deaths (NRAD) (2011–2014)[1] identified a number of potentially preventable risk factors in those who died, many of which had been recognised previously[2,3]. Commissioning Group (CCG) in England, UK performed a quality audit[4] of 27,587 people of all ages diagnosed with asthma (prevalence 7%; range 4–12%) to identify the prevalence of some of the risk factors identified in the NRAD report. The results identified a wide variation in process of care and presence of risk factors, including excess short-acting bronchodilator reliever (short-acting beta-2-agonist (SABA) bronchodilators) and insufficient inhaled corticosteroid (ICS) controller prescriptions, failure to issue personal asthma action plans (PAAPs) or to perform annual reviews or to check inhaler technique. In North West London (NWL), eight CCGs set up the Whole

Objectives

Results

Conclusion