Paediatric asthma care in the UK: fragmented and fatally fallible

The National Review of Asthma Deaths (NRAD) report entitled Why Asthma Still Kills ,1 published on World Asthma Day in May 2014, concluded that only one of the 28 children and young people (CYP) who died had been adequately managed by health professionals. Of the 19 NRAD recommendations only one has been initiated nationally in the UK, namely setting up a National Asthma Audit, which has yet to report after nearly 5 years. Care for children with asthma in the UK is mainly provided in primary care, and is often limited to the few tasks set out in the Quality and Outcomes Framework (QOF)2 to provide data to qualify for payments. Currently the QOF requires a recorded asthma diagnosis confirmed by measures of airflow reversibility, smoking status, and evidence of an asthma review in the preceding 12 months that includes an assessment of asthma control using the Royal College of Physicians’ three questions (RCP 3 Questions); the latter are not validated and nor are they recommended for children aged <16 years by the UK Asthma Guidelines.3 The aim of the NRAD was to identify potentially preventable factors related to care preceding these tragic (and often preventable) deaths. The confidential inquiry identified a number of key themes associated with potentially preventable asthma deaths, which included: lack of objective evidence for the diagnosis of asthma and certification of death due to asthma; excess prescriptions and overreliance on reliever medication; insufficient prescriptions (and collection) of preventer (controller) medications; lack of provision of education for patients (in the form of personal asthma action plans [PAAPs]); and, importantly, a marked failure by health professionals, patients, and their carers to recognise risk of poor outcome in those who have already had at least one asthma attack. All these factors were previously known from …