Asthma

Asthma is the most common long term condition among children and young people and is one of the top ten reasons for emergency hospital admission in the UK.

The UK has one of the highest rates of asthma deaths among 10-24 year olds in Europe

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

The school has a lack of knowledge on asthma – when he is having a bad day I keep him off school because I worry that they won’t help him. A teacher has said that 'he uses the inhaler as a distraction'.

Parent speaking to RCPCH &Us

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.

Additional information

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

  • NHS England should support the ongoing establishment of a UK wide clinical network for asthma, as per the Long Term Plan commitment. Appropriate support and resources must be provided to support key network functions at national and regional levels. Networks should include links to mental health, education and transition and include input from both multidisciplinary professionals and family / young person engagement.
  • All units across England should engage with the Royal College of Physician’s National Asthma and COPD Audit Programme (NACAP).
  • NHS England should review and update the asthma Quality and Outcomes Framework (QOF) indicators, to ensure children and young people are included and meaningfully measure the quality of care that they receive.
  • NHS Scotland should support the ongoing establishment of a UK-wide clinical network for asthma. Appropriate support and resources should be provided to support key network functions at national and regional levels. The network should include links to mental health, education and transition and include input from both multidisciplinary professionals and family / young person engagement.
  • All units across Scotland should engage with the Royal College of Physician’s National Asthma and COPD Audit Programme (NACAP). NHS Health Boards should support this data collection.
  • NHS Wales should support the ongoing establishment of a UK wide clinical network for asthma. Appropriate support and resources should be provided to support key network functions at national and regional levels. The network should include links to mental health, education and transition and include input from both multidisciplinary professionals and family / young person engagement.
  • All units across Wales must engage with the Royal College of Physician’s National Asthma and COPD Audit Programme (NACAP).
  • HSC Northern Ireland should support the ongoing establishment of a UK wide clinical network for asthma, building on existing professional networks. Appropriate support and resources should be provided to support key network functions at national and regional levels. Networks should include links to mental health, education and transition and include input from both multidisciplinary professionals and family / young person engagement.
  • Northern Ireland Executive & Department of Health should support the expansion of the Royal College of Physician’s National Asthma and COPD Audit Programme (NACAP) to cover units in Northern Ireland, or collect and report comparable data with accompanying action planning and quality improvement.

What can health professionals do about this?

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

Royal College of Paediatrics and Child Health (2020) State of Child Health. London: RCPCH. [Available at: stateofchildhealth.rcpch.ac.uk]

References

(1)

Ferrante, G., & La Grutta, S. (2018). The Burden of Pediatric Asthma. Frontiers in Pediatrics, 6, 186.

(2)

Asthma UK ‘Asthma Facts and Stats

(3)

Keeble E, Kossarova L (2017) QualityWatch Focus on: Emergency hospital care for children and young people – What has changed in the past 10 years? April 2017: Nuffield Trust.

(4)

Shah, R., Hagell, A. & Cheung, R. (2019) International comparisons of health and wellbeing in adolescence and early adulthood. Nuffield Trust & Association for Young People’s Health: January 2019.

(5)

Royal College of Physicians (2014) Why asthma still kills: The National Review of Asthma Deaths (NRAD).

(7)

NHS Digital (2018). Health Survey for England, 2018.

(8)

Williams ML et al. (2018) ‘Chapter 8: Impact of air pollution scenarios on inequalities’ in Williams ML et al  ed. (2018) Public Health Air Pollution Impacts of Pathway Options to Meet the 2050 UK Climate Change Act Target: A modelling study. NIHR Journals Library

(9)

Kossarova L, Cheung R, Hargreaves D, Keeble E. (2017) Admissions of inequality: Emergency hospital use for children and young people. December 2017: Nuffield Trust.

(10)

Kossarova L, Cheung R, Hargreaves D, Keeble E. (2017) Admissions of inequality: Emergency hospital use for children and young people. December 2017: Nuffield Trust.

(11)

Royal College of Physicians (2014). Why asthma still kills: The National Review of Asthma Deaths (NRAD).

(12)

Asthma UK (2019). Living in limbo: the scale of unmet need in difficult and severe asthma

(13)

Asthma UK. Health inequality and asthma.