National audit of acute severe asthma in adults admitted to hospital. Standards of Care Committee, British Thoracic Society.
OBJECTIVE
To ascertain the standard of care for hospital management of acute severe asthma in adults.


METHODS
Questionnaire based retrospective multicentre survey of case records.


METHODS
36 hospitals (12 teaching and 24 district general hospitals) across England, Wales, and Scotland.


METHODS
All patients admitted with acute severe asthma between 1 August and 30 September 1990 immediately before publication of national guidelines for asthma management.


METHODS
Main recommendations of guidelines for hospital management of acute severe asthma as performed by respiratory and non-respiratory physicians.


RESULTS
766 patients (median age 41 (range 16-94) years) were studied; 465 (63%) were female and 448 (61%) had had previous admissions for asthma. Deficiencies were evident for each aspect of care studied, and respiratory physicians performed better than non-respiratory physicians. 429 (56%) patients had had their treatment increased in the two weeks preceding the admission but only 237 (31%) were prescribed oral steroids. Initially 661/766 (86%) patients had peak expiratory flow measured and recorded but only 534 (70%) ever had arterial blood gas tensions assessed. 65 (8%) patients received no steroid treatment in the first 24 hours after admission. Variability of peak expiratory flow was measured before discharge in 597/759 (78%) patients, of whom 334 (56%) achieved good control (variability < 25%). 47 (6%) patients were discharged without oral or inhaled steroids; 182/743 (24%) had no planned outpatient follow up and 114 failed to attend, leaving 447 (60%) seen in clinic within two months. Only 57/629 (8%) patients were recorded as having a written management plan.


CONCLUSIONS
The hospital management of a significant minority of patients deviates from recommended national standards and some deviations are potentially serious. Overall, respiratory physicians provide significantly better care than non-respiratory physicians.
Fazakerley Hospital, Liverpool.
M G
MG
Pearson
I
I
Ryland
B D
BD
Harrison
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001249:Asthma / Q000453:epidemiology / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008485:Medical Audit / Q000706:statistics & numerical data*; D008499:Medical Records; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011787:Quality of Health Care; D012139:Respiratory Therapy Department, Hospital / Q000592:standards*; D011795:Surveys and Questionnaires; D006113:United Kingdom / Q000453:epidemiology