Hospital nurses involved in discharging children after severe asthma attacks should broach the issue of environmental tobacco smoke with parents or carers, according to the authors of a major audit.
Exposure to environmental tobacco smoke was one of the key areas of concern highlighted in the audit, being reported in 32% of children treated or admitted to hospital for a severe exacerbation.
“It’s very worrying that a third of children were potentially exposed to tobacco smoke at home”
The audit authors described the level of exposure as “worrying”, because tobacco smoke was known to be a “key trigger” for asthma attacks that required hospital admission.
A “significant proportion” of trusts did not provide the requested data on the topic, said the authors, suggesting clinical teams may need to pay greater attention to asking about exposure to smoking.
They said healthcare professionals should “always discuss the issue of environmental tobacco smoke with parents or carers and, where appropriate, provide education about the role of tobacco smoke in worsening asthma, and the pivotal need to minimise exposure in children”.
Smoking cessation support should also be given as appropriate, according to the authors of the national audit, published today by the British Thoracic Society.
Overall, the audit concluded that better education and review was needed at the point of discharge for children experiencing severe asthma attacks in order to reduce re-admission.
“Health professionals need to do more to inform parents of the health risks of second-hand smoke”
Most aspects of discharge from hospital were found to be “less than optimal”, said the auditors.
For example, only 56% of children and families or carers were given a personal asthma action plan, and only 42% of children were reported to have had their asthma inhaler technique assessed.
The researchers warned that inadequate discharge procedures could be contributing to the current hospital re-admission rate of 15%.
They noted that provision of, and adherence to, action plans has been shown to improve asthma control and reduce the number of exacerbations needing admission to hospital.
In addition, contrary to national guidance, they found only 24% of families or carers and their children were advised to visit their GP within two working days after discharge from hospital.
Chest X-rays and antibiotics were used more frequently than evidence suggests is appropriate, added the audit authors.
However, the audit revealed that children admitted with severe asthma attacks generally received “very effective and efficient” treatment and care while in hospital.
The BTS National Paediatric Asthma Audit reviewed over 5,500 sets of data in 153 hospitals and healthcare settings across the UK in November 2015, probing the quality of emergency care and outcomes for children aged over one admitted with severe asthma attack.
Positive areas highlighted in the audit included that clinical care for children with acute wheezing and asthma continued to be highly efficient and effective, and most children received appropriate “first line” rescue treatment and care.
In addition, hospital stays were short – more than 70% of children were in hospital for one day or less – with a substantial proportion receiving care entirely within the emergency department.
Meanwhile, second line treatment used for children with more severe attacks, such as intravenous therapies or ventilation, and the use of the paediatric intensive care unit, were only required in a very small proportion of children.
Dr James Paton, reader in paediatric respiratory medicine at the University of Glasgow, who led the audit, said: “The good news is that first line rescue care and treatment for children suffering from acute wheezing and asthma is generally working extremely well in hospitals. This is very welcome.
“Overall, children are receiving the right treatments, and admission to paediatric intensive care is only needed in a very small proportion of cases. Hospital stays are generally very short,” he said. “This all points to good practice and adherence to national guidance.
“However, there are some ‘red flags’ highlighted in the report,” warned Dr Paton.
Nurses urged to warn of smoking risk to children with asthma
“It’s very worrying that a third of children were potentially exposed to tobacco smoke at home,” he said. “When discharging children, health professionals should take the opportunity to talk about the issue with their parents or carers – and offer smoking cessation support as appropriate.”
He added: “Above all, it is paramount that children, families and carers leave hospital with a personal asthma action plan that provides guidance and practical tools on managing and monitoring asthma effectively.”
Deborah Arnott, chief executive of anti-smoking charity ASH, said: “This study highlights the importance of making homes smoke free since that is where children are most likely to be exposed to tobacco smoke, which can trigger asthma attacks.
“Health professionals need to do more to inform parents of the health risks of second-hand smoke, particularly to their children, and also to support parents who smoke to quit,” she said.
Meanwhile, a separate survey by the charity Asthma UK has suggested that three-quarters of patients with severe asthma need “regular emergency care”.
“We want to hear from more people with severe asthma”
The survey of 253 patients found that 45% had been admitted with life-threatening asthma attacks more than 10 times since they were diagnosed.
Furthermore, 38% of respondents to the “pilot study” said it took a few years to find the right combination of medicines for them.
In addition, 96% of respondents said the general public did not understand what it was like to live with the “constant unpredictability of severe asthma”.
Patients with severe asthma and parents of children with the condition both reported impact on quality of life, with 66% saying it had made them or their child anxious, and 55% citing depression.
Asthma UK has now launched a wider survey to capture people’s experiences of living with severe asthma.
Dr Samantha Walker, the charity’s director of research and policy, said: “We want to hear from more people with severe asthma to better understand their needs and experiences.”
Results from the Asthma UK pilot survey
Impact on quality of life
- 68% say severe asthma holds them back in work and school
- 71% say severe asthma affects their social life
- 54% say it holds them back from going on holiday
- 66% say severe asthma has made them (or their child) anxious
- 55% say having severe asthma has made them (or their child) depressed
- 55% say it’s affected their confidence
- 50% say it affects family life
Number of A&E visits since diagnosis
- 75% say they’ve been to A&E more than three times (for themselves or their child) because of an asthma attack
- 45% say they’ve been to A&E more than 10 times (for themselves or their child) because of an asthma attack