Children admitted with acute wheeze/asthma during November 1998-2005: a national UK audit

Objective: To report 8 years' data from a UK-wide audit of acute wheeze/ asthma management in children carried out annually since 1998. Design: Paediatricians were invited to complete a simple form based on British Thoracic Society (BTS) asthma guidelines for any child over 1 year of age admitted with acute wheeze/asthma each November from 1998 to 2005. Information was collected about patient demographics, initial hospital severity assessment, in-hospital treatment, asthma education and emergency planning, discharge treatment and follow-up. Results: Data on 9429 admissions were available, with between 53 and 67 centres participating each year. The majority of children were under 5 years of age (median age 3 years). Nearly all were treated with bronchodilators, and around 90% received systemic steroids. Vital signs (pulse and respiratory rate) and oxygen saturation on admission remained stable over the audit period. However, the proportion of admitted children given bronchodilators exclusively by spacer increased from 7% to 44% between 1998 and 2005. The proportion discharged with written asthma plans increased from 24% to 41%. Wide variations were noted between centres in the proportions of children receiving chest x rays and written asthma plans. Children admitted under the care of a respiratory specialist were more likely to have documentation that they had been given written asthma information and a written asthma plan and had had their inhaler device technique checked than if under the care of a general paediatrician. Conclusions: In many areas, hospital treatment closely followed published guidance. However, some important deficiencies were noted and variations remain. As well as monitoring guideline implementation, national audit can highlight opportunities for research and improving care locally and nationally.