Differences in hospital asthma management.

Asthma management was audited prospectively for one year in a large teaching hospital. Full details were available on 77% of all patients admitted, or readmitted, with asthma during that year (150 of 195 admissions). 64 patients were admitted to general wards with a special interest in respiratory medicine, and 86 to general wards without this specialist interest. Cases in the two groups were similar in terms of age, previous severity of asthma, previous treatment, and initial pulse rate. Fewer cases in the non-specialist group were treated with oral corticosteroids (67%, vs 83%), had regular peak flow recordings (42%, vs 73%), or were given return appointments (56%, vs 92%); and fewer had their regular inhaled therapy increased after discharge (28%, vs 55%). At interview 13 days later, more patients from the non-specialist group reported sleep disturbance (41%, vs 23%), morning chest tightness (55%, vs 37%), ow wheeze on 1 flight of stairs (58%, vs 34%). 20% of first admissions in the non-specialist group were readmitted within the year, compared to 2% of the group treated on wards with a specialist interest in respiratory medicine. These data suggest that the intensive management of asthmatic patients, practised in respiratory units, prevents much unnecessary morbidity.