Childhood asthma, can admissions be avoided?

Since admissions with asthma continue to increase and account for considerable morbidity, we chose to prospectively study asthma admissions over a one year period to assess the severity of patients' asthma, their need for treatment available only in hospital, and to assess the adequacy of their prehospital treatment. A study proforma was completed soon after the admission of each child. Data gathered between the 1st January and 31st December 1990 are presented. There were 105 children admitted, two-thirds of those were boys and just over half were aged less than 5 years. Eighty-seven children had a previous diagnosis of asthma. Overall the attacks were not severe, only 10 patients were treated with intravenous medication and 18 children required continuous oxygen. Sixteen patients required hospitalisation for more than 48 hours, the remainder were discharged within 2 days. Suboptimal prehospital care was identified in a third of patients, inappropriate management of the acute attack, failure of adequate prophylactic medication and non-compliance with prescribed regimes were common. In our hospital, admissions with acute severe asthma have declined in 1990, attention to simple treatment schedules may further reduce hospitalisation.