1. Introduction Project At Crown Street Surgery:
Asthma In Children 1) Is the current method of encouraging paediatric patients on the asthma register to attend their annual asthma review effective? 2) Are all paediatric asthma patients at Crown Street Surgery managed in accordance to BTS/GINA guidelines?
Introduction
In the UK, 3 people a day die from asthma[1]
No significant decrease in no. of deaths despite advances in newer treatments and increased awareness[1]
Asthma deaths can be easily preventable with the right education and management [2]
The NRAD study found that 50% of the deaths were in those with mild-moderate asthma[2]
At Crown Street Surgery:
5% prevalence of asthma in surgery compared to national prevalence of 6% [QOF indicator]

2. NICE + BTS endorse annual asthma reviews.
QUESTION 1: Is the current method of encouraging paediatric patients on the asthma register to attend their annual asthma review effective?
NICE + BTS endorse annual asthma reviews.
BTS states that asthma is monitored best at least once on an annual basis[3]
Content to be covered in an annual review:[3]
Symptom score
Inhaler technique
Asthma attacks, oral corticosteroid use
Adherence to treatment
Personalised asthma action plan
Exposure to tobacco smoke
Growth

3. Percentage of paediatric patients who attended their annual asthma review
Our results
National results[4]
We found that out of the 420 asthmatic patients at the surgery 73.3% (308/420) had had a review in the past 12 months.
The figure was higher in those under 18 and was 79.8%
Asthma UK survey found that 81% of patients under 17 had had an annual review.
On average 80% of the population had attended their annual asthma review.[4]

4. Reasons for not coming in for an Annual Asthma Review
Our results
National Results

5. Analysis
Nationally the most common reason for people not attending was that they had not been reminded. This didn’t seem to be the main reason at Crown Street Surgery when we spoke to patients
The main reason was that the parents/ carers didn’t think that their child had outgrown asthma or thought that their child’s asthma was well controlled.
This suggests that more could be done to explain the reasoning behind the annual asthma review i.e. to discuss medication and even cutting down medication if the patient hasn’t been experiencing symptoms

6. Asthma Action Plan results
Our results
National Results[4]
70.2% patients had an asthma action plans
A few of the people who we called who didn’t have an asthma action plan didn’t know what one was

7. Proposed intervention?
We made an asthma leaflet which we feel would be useful to hand out to patients at the annual asthma reviews/ as they are newly diagnosed.

8. Question 2: Are all paediatric asthma patients at Crown Street Surgery managed in accordance to BTS and GINA guidelines?
British Thoracic Society 2016
Global Initiative for Asthma [
Recommended that all children with diagnosis of asthma are on an inhaled corticosteroid regardless of the symptoms they show. BTS shows step model- need to go up or down steps
Regular low dose ICS is recommended for all patients with a diagnosis of asthma

9. GINA guidelines 2018
For the best outcomes, regular daily controller treatment should be initiated as soon as possible after the diagnosis of asthma is made, because:
early treatment with low dose inhaled corticosteroids (ICS) leads to better lung function than if symptoms have been present for more than 2–4 years
patients not taking ICS who experience a severe exacerbation have lower long-term lung function than those who have started ICS
in occupational asthma, early removal from exposure and early treatment increase the probability of recovery
Regular low dose ICS is recommended for all patients with a diagnosis of asthma

10. BTS and GINA Guidelines
Question 2: Results
CSS results
BTS and GINA Guidelines
Regular low dose ICS is recommended for all patients with a diagnosis of asthma

11. Ques 2: Results CSS results Guidelines
To comply with recommendations, most patients would usually need at least 12 preventer prescriptions per year i.e. one a month (Royal College of Physicians, Why asthma still kills: The National Review of Asthma 2014)

12. Ques 2: Results Our results National Guidelines
No patients were prescribed 12 preventer inhalers – the most was 7x 200mcg over the past year
No patients aged 3-18 were prescribed more than 12 reliever inhalers over the past year – 32 patients had been prescribed 4 or more (200mcg)
To comply with recommendations, most patients would usually need at least 12 preventer prescriptions per year[3].
Anyone prescribed more than 1 short-acting bronchodilator inhaler a month should have their asthma assessed [2]

13. Proposed intervention?
Making sure at every asthma review to check that child is using preventer inhaler regularly and encourage to do so if they are not
Putting a BTS/GINA step ladder in every consulting room – as soon as asthma is diagnosed, put on preventer
Creating a pop-up on patients who are on Salbutamol PRN only when their Systemone record is opened
Education: presentation