Post-attack asthma reviews

I read Dr Edwards’ letter in response to the article by Punyadasa et al.¹ Unfortunately the outcome of this study was whether any post-admission intervention occurred, and these ranged quite widely, without considering readmission, further attacks, or deaths. The National Review of Asthma Deaths (NRAD)² and subsequent inquests provided considerable evidence of poor care for people who died from asthma attacks. Most asthma attacks, hospital admissions, and deaths can be prevented by ensuring that appropriate preventer medication is prescribed, collected, and correctly taken.² That’s the reason why a post-attack review was recommended many years ago in the UK asthma guidelines³ and subsequently included in the requirements for Quality and Outcomes Framework (QOF) payment. So the need for a post-attack or post-admission review following an asthma attack is really based on common sense. Furthermore, as asthma is a chronic condition it is illogical to simply treat attacks without trying to identify any modifiable risk factors and adjust management to deal with these. The British Thoracic Society annual audits⁴ continue to show fairly high numbers of people readmitted following asthma admissions. We did a detailed audit⁵ of children and young people (CYP) in 34 practices where modifiable risk factors⁶ (see Box 2-2) were identified, with clear guidance provided for the practices on suggested actions in these CYP. As a result, admissions in CYP reduced by 16% the following year. While this was a relatively small study, it demonstrated that detailed post-attack reviews can identify and deal with modifiable risk factors with reduction in unscheduled care.

Further to Dr Edwards’ point about evidence, this could so easily be provided dynamically if access to GP records was made available to bodies such as the NHS.

It’s now 10 years after the NRAD was published² and we are still seeing very high numbers of preventable asthma deaths and admissions in the UK. Simply changing attitudes and managing asthma as a chronic (not an acute disease) would improve patient outcomes and reduce GP and hospital workload from unscheduled care.