2014 Report (adults and kids) finds that routine asthma care, management of previous and final attacks is generally poor, but particularly for children cf adults.

Almost half did not seek medical help before death. 10% deaths within 1 month of discharge from hospital for asthma. Many being treated for mild/mod asthma, but review suggested prob poorly controlled severe asthma. Widespread over reliance on reliever inhalers and underuse of preventers. Overall 39% had used more than 12 blue inhalers in the year before death. 80% of deaths did not get 12 preventer inhalers in the previous year. Nearly half had not had an asthma review in previous year.

Poor follow up of previous severe attacks (but only about 20% had been in A&E in the previous year).

Delays in primary and secondary care in about a 1/3 of final attacks.

In 93% children and young people, one or more avoidable factors relating to patients, their families and their environment: eg exposed to smoke or smoked,  allergy,
Poor recognition of risk of adverse outcome from asthma.

Recommendations

Any patient prescribed more than 12 relievers in a year should have urgent review. Follow up should be made after every ED attendance for asthma. Every hospital discharge should have hospital outpatient follow up.

Should have personal asthma action plan (PAAP).

Better education on when to use asthma medication, recognise poor control, how/when to seek emergency advice.

For parents/patients

Triple A online test!

See GP within 48hrs of discharge.

Associations with depression and anxiety. Obesity mentioned.