A quality assurance review of outpatient care of children with life-threatening asthma exacerbations

Objectives: A hospital admission for asthma represents an opportunity to ad dress and improve asthma control. The aims of this study were to compare th e ambulatory care of children admitted to the intensive care unit (ICU) fol lowing a life-threatening asthma exacerbation with published guidelines of asthma management and to identify areas that could be targeted for change. Methods: A retrospective review of case notes of children admitted to the I CU with asthma over a 6-month period. Variables recorded were: demographic; asthma history (including prior pattern of asthma, hospital admissions, in terval treatment and managing doctor); admission details (consultation of r espiratory team and asthma educator); and discharge management. Results: There were 40 admissions of 38 children (24 males) with mean age 5 .7 years (range 1.1-14 years). The majority (58%) had previous admissions f or asthma (55 admissions in 22 children), with 23% of these to ICU. Sixty t hree per cent of those with previous admissions had persistent asthma, but only 29% were on inhaled corticosteroid (ICS). Most (60%) were managed by t heir local medical officer (LMO). Use of ICS was more likely if managed by a paediatrician. A respiratory subspecialist was consulted in 42% and the a sthma educator in 70% of ICU admissions. Discharge medication included ICS in 74%, with no interval treatment in 18% of admissions. Follow up was by a respiratory subspecialist in 25% of cases. Conclusion: Asthma management before and after admission with life-threaten ing asthma did not conform to available guidelines. Persistent asthma was u nder-treated. Paediatricians were more likely to use interval treatment tha n LMO. We identified areas in which quality of care and outcome could be im proved in this vulnerable group of asthmatics.