Background

• Asthma is the most common long term condition among children and young people,¹ with 1.1 million children currently receiving asthma treatment.² It continues to be among the top 10 causes of emergency hospital admission for children and young people in the UK.³
• The UK has among the highest mortality rates in Europe for children and young people with the underlying cause of asthma.⁴
• Emergency admissions, and deaths, related to asthma are largely preventable with improved management and early intervention. The National Review of Asthma Deaths found that 46% of the children who died from asthma had received an inadequate standard of asthma care.⁵
• Emergency asthma admission rates have fallen since 2003/4 across the UK, however there continues to be widespread geographical variation.⁶
• Emergency admissions for asthma are strongly associated with deprivation despite the prevalence of asthma being evenly distributed.⁷ Children and young people living in deprived areas are more likely to be exposed to higher levels of tobacco smoke and environmental pollution, which may contribute to this.⁸ If emergency admission rates for all children and young people were at the levels experienced by the least deprived group, this could save the NHS £8.5 million per year in England alone.⁹

Key findings

• Emergency hospital admissions for asthma are falling. The rate of emergency hospital admissions for asthma among children and young people aged under 19 in 2017/2018 was 174 in England, 165 in Wales and 157 in Scotland (all per 100,000 children and young people aged 0-18 years).
• Deprivation continues to be a risk factor for emergency hospital admissions for asthma.
  • England: In 2005/06 the most deprived school-aged children in England (aged 5-14 years) were 2.2 times more likely to have an emergency admission for asthma than their least deprived counterparts. By 2015/16 this increased to about 2.5 times.¹⁰
  • Scotland: In 2017/18, children and young people aged 0 to 18 years living in the most deprived areas in Scotland were more than three times more likely to be admitted to hospital as an emergency for asthma, compared to the least deprived areas.
• There has been a small reduction in the total amount of deaths among children and young people as a result of asthma. In 2017, 17 0-14 year olds and 22 5-24 year olds died in the UK.

What does good look like?

Getting the basics right in asthma care. Many emergency admissions for asthma can be prevented simply by making sure that basic asthma care is being delivered, such as education and self-management, access to routine asthma check-ups and up to date personal asthma action plan. The National Review of Asthma Deaths found that only 23% of the children who died from asthma had a personalised asthma management plan.¹¹

Better access to specialist care where appropriate. Most children with asthma should be managed in primary care. When specialist care is necessary, there is often a lack of capacity to deliver specialist care to a high standard.¹² The National Review of Asthma Deaths found that fewer than half of patients who died from asthma had specialist asthma care. Commissioners should assess this unmet need both nationally and locally, and deliver adequate provision of treatments supported by current best evidence.

To reduce health inequality in asthma and enable people to better adhere to self-managed treatment, there must be preventative action on causes and triggers (including air pollution, both indoor and outdoor), improved access to basic care, and digital innovation to improve engagement in healthcare and health literacy.¹³

Policy recommendations

What can health professionals do about this?

• All children should be provided with a personal asthma action plan, to help them (and their families) better understand and manage their day to day asthma care, as well as what actions to take in an emergency.
• Ensure that children have regular (at least annual) reviews of their asthma care, including: inhaler technique; medications review; preventive advice on tobacco smoke (both active and passive); allergy review; and consideration for escalation of care and/or referral to secondary or tertiary services if required. Clinical guidance is available:
  • NICE guidance (NG80) on diagnosis and management of asthma for children and young people (2017)
  • British Thoracic Society / Scottish Intercollegiate Guideline Network Guideline for the management of asthma (2019)
• Provide children and young people with education and self-management tools, particularly for school-aged children and young people transitioning into adult services.
• Audit and data. Make sure your service is participating in the National Respiratory Audit Programme (NRAP) [previously known as NACAP], and use the findings to understand what you are doing well and how your service could be improved.

Contributing authors

• Jacob Avis, RCPCH Research & Quality Improvement Division
• Dr Ronny Cheung, RCPCH State of Child Health Clinical Lead
• Rachael McKeown, RCPCH State of Child Health Project Manager
• Dr Rakhee Shah, RCPCH State of Child Health Clinical Advisor