A number of evidence-based risk factors for poor outcomes in asthma have been identified. In 2014, the UK National Review of Asthma Deaths (NRAD) found widespread problems in the quality of care of individuals who died between 2011 and 2013. In the review of children, care was found to be below the expected standards in 46% of deaths.
In the NRAD, risk factors such as variations in care, excess short acting inhalers, insufficient controller prescription, failure to check inhaler technique and failure to issue personal asthma action plans or to perform annual reviews were identified.
Some of these risk factors have been known for nearly 50 years, and of 19 recommendations to reduce these, only one has been implemented to date. Sadly, the UK’s poor record of asthma care persists and there are continued examples of preventable asthma attacks and childhood asthma deaths.
In collaboration with a North West London (NWL) GP, the Discover-NOW team examined the burden of asthma and risk of poor outcomes in children and young people in NWL, aiming to guide the NWL clinicians and managers responsible for providing and commissioning care, to reduce modifiable risk factors for poor asthma outcomes, and subsequent unscheduled health care.
The team conducted a retrospective analysis of care for children and young people in NWL, who had a diagnosis code for asthma in General Practice between April 2018 and March 2019, using the depersonalised dataset accessed through Discover-NOW, the Health Data Research Hub for Real World Evidence.
This study was completed over the last 12 months and demonstrates that up to 10% of children and young people with asthma in NWL face potential life-threatening asthma attacks and remain at risk of poor outcomes due to their asthma. Additionally, it is clear from this data that not all asthma exacerbations were coded as such by the general practitioners, making it difficult to identify those in need of a post exacerbation review as recommended in NICE and the SIGN/BTS. These results highlight that utilisation of dynamic clinical risk registers available in North West London could easily facilitate recognition of risk and optimisation of care for children and young people with asthma.
The findings of this study have been accepted for presentation at the September 2020 meeting of European Respiratory Society as an abstract and have been submitted to the BJGP as a manuscript.