Transformation Partners in Health and Care > Resources > London asthma toolkit for children and young people > Clinical Care > Asthma reviews

Asthma reviews

This section is intended for clinicians caring for children with asthma in primary, community, hospital or tertiary care setting. It outlines examples of best practice in the assessment, treatment and ongoing management of children and young people with asthma.

Asthma Reviews

Asthma reviews should be undertaken annually and after every asthma attack. Reviews after an asthma attack are referred to as 48 hour reviews and often take place in primary or community care. Doing a thorough asthma review takes at least 20 minutes and should be a combination of clinical assessment and patient education. The child’s personal asthma action plan should be reviewed with the child and family so that they understand what steps should be taken for their self management and inhaler technique should be visually checked. It is important to conclude if it is asthma, if it is controlled and do I need to change management through asking the right questions and following the steps included in asthma review templates.

A study by Salisbury et al (2002) achieved 91% attendance by holding asthma reviews in a school setting compared to 51% for practice-based review. Read about a randomised controlled trial of clinics in secondary schools for adolescents with asthma.

Asthma Control Tests (ACT)

An asthma control test helps to:

  • ensure that the correct diagnosis has been made
  • ensure the child is on the appropriate prescribing management step and it is clearly documented
  • identify potential barriers and reasons for poorly controlled asthma: using an Asthma Control Test (ACT) see examples below:

48 hour reviews

The NICE quality statement 4 (2018), NHS England’s National Bundle of Care for children and young people with asthma and the London Asthma Standards require any child who has received treatment in hospital or through out-of-hours services for an acute exacerbation of asthma, a follow up by their own GP practice within two working days of discharge. Guidance  on what should be included and a  48-hour review checklist

This review allows an assessment of the patient as they recover from an exacerbation and to review if their background control is optimal. The 48 hours is in keeping with observations that the majority of these children will have been discharged with at least three days of oral steroids following their exacerbation.

Acute care should ensure that notification of a child’s presentation out of hours or in an emergency is sent to the primary care provider within 24 hours. Primary care need to ensure that there is a system in place to flag these summaries and to feedback to the acute care provider if this requirement is not met.

St George’s has produced a leaflet aiming to ensure that the person discharging the patient emphasises that the review is needed in 48 hours, the parent knows why the review is important and that the GP or practice nurse, if shown the leaflet, knows what is expected.

Was not brought/did not attend

Characteristics of children who do not attend their hospital appointments, and GPs’ response: a mixed methods study in primary and secondary care | British Journal of General Practice (bjgp.org).

Mid and South Essex ICS has produced an ICS approach to safeguarding children with asthma.

Recording asthma reviews in primary care

One of the recommendations of the National Review of Asthma Deaths (NRAD) was the implementation of a National Asthma Template for consultations in primary care. On this page you will find a number of templates intended both as learning tools as well as for the purpose of recording good quality records in primary care.

Resources