Hospital asthma management - a comparison between general medical units with and without a respiratory input

Full details including admitting ward were available for 77% (150) of all asthma admissions in a prospective audit of hospital asthma management. Cases could be subdivided into 64 admitted to general wards with a respiratory input (A) and 86 to similar wards without such specialist interest (B). Cases in A and B were similar in terms of age, previous severity of asthma, previous treatment and initial pulse rate. Fewer cases in B were treated with oral corticosteroids (A 83 %, B 67%; p = 0.04), had regular peak flow recordings made (A 73%, B 42%; p<0.005) or review planned (A 92%, B 56%; p<0.005) and fewer had their regular inhaled therapy increased after discharge (A 55%, B 28%; p<0.005). These differences in management were associated with more cases from B reporting sleep disturbances (A 23 %, B 41 %; p = 0.03), morning chest tightness (A 37%, B 55%; p=0.03) or wheeze on one flight of stairs (A 34%, B 58%; p<0.005) at interview 13 days later. In addition 20% of cases first admitted to B were readmitted within the year compared with 2% for A. The better outcome in cases admitted to A shows that the more intensive management practised in these wards is worthwhile.