LAUSR

Introduction Early treatment of asthma attack is recommended and improves outcomes. Using audit data of acute asthma admissions in secondary care, we investigated whether: Patients admitted with severe and life-threatening asthma were more likely to receive systemic steroids, beta-agonists, and a peak expiratory flow (PEF) measurement, and receive these more quickly, than patients with less severe asthma Patients with more severe asthma were more likely to be reviewed by a specialist Initial actions impacted on length of stay (LOS) and mortality Methods The Royal College of Physicians National Asthma and COPD Audit Programme began a continuous audit on acute asthma in secondary care in November 2018. 170 hospitals in Britain provided data on asthma admissions from November 2018-March 2019. Data were collected on patient characteristics and care received. Multi-level logistic and linear regression were used to analyse associations between asthma severity (defined using NICE guidelines), care, and outcomes. Results 10,428 asthma admissions were inputted, of which 10,242(98.2%) were suitable for analysis. 34.6% (N=3,547), 51.4% (N=5,266), and 14.0% (N=1,429) of patients were admitted with moderate, severe, and life-threatening asthma respectively. 87.7% (N=8,986) received systemic steroids on arrival, 91.3% (N=9346) were administered beta-agonists and 72.6% (N=7,436) had their PEF measured on arrival. 76.8% (N=7,870) of patients received a specialist respiratory review. After adjusting for age and hospital, patients with severe and life-threatening asthma were more likely to receive systemic steroids, beta agonists, and PEF measurement compared to those with moderate asthma (p<0.001), and were more likely to receive this sooner (p<0.001). Patients with more severe asthma were more likely to receive a specialist respiratory review (p<0.001). After adjusting for age and asthma severity, PEF measurement on arrival was associated with reduced mortality (adj-OR=0.27, 95%CI 0.08–0.75). Receipt of systemic steroids, beta-agonists, and PEF measurement within 1 hour of arrival was associated with a -3.6% (95%CI -7.7%-+0.5%), +1.9% (-2.1%-+6.0%) and -19.2% (-23.5%- -14.7%) change in LOS respectively. Conclusion Patients with more severe asthma were more likely to receive optimal asthma care. PEF measurement on arrival was associated with survival and patients that received PEF within one hour had a shorter LOS.