British Thoracic Society audit of hospital-based asthma care

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Only 59% of hospitals have a specialist asthma service and just 56% have a designated clinical lead for asthma services, an audit by the British Thoracic Society (BTS) has found.

The 2016 British Thoracic Society Adult Asthma Audit was the largest to date, involving 171 hospitals in 136 trusts, with data available for 4258 patients. It found that despite the availability of national guidelines and the report of the National Review of Asthma Deaths in 2014, outcomes remain largely unchanged since in the last audit 4 y ago.

More than 3% of admissions were severe enough to warrant a critical care team review. 4% of patients were admitted to critical care, with 1% receiving intubation.

Nearly 89% had a previous diagnosis of asthma, but only 42% had a diagnosis supported by objective testing. 1 in 5 did not receive a peak expiratory flow reading at admission. Two-thirds received regular inhaled corticosteroids (ICS) prior to admission. Contrary to current guidelines, almost 1 in 10 were discharged without ICS.

The results are worrying considering that during the 2-mo audit period, 33 deaths due to asthma were recorded.

On foot of the audit, the BTS has set out 4 national improvement objectives to be achieved before a re-audit in 3 years’ time. The objectives are that all hospitals have a specialist asthma service with a named medical lead; 95% of patients receive a dedicated discharge care bundle; 95% have peak expiratory flow measured on admission, including postbronchodilator peak flow; and 95% of patients to be discharged on ICS.