Implementation and effectiveness of guideline-recommended clinical activities for children with asthma: population-based cohort.

Abstract

Background: Guidelines advise minimising asthma exacerbation risk is achieved partially through good clinical practice activities, including scheduled asthma reviews, inhaler technique checks and asthma management plans. We assessed how frequently these activities are provided and how effective they are in clinical practice.

Research question: Do guidelines-recommended activities such as asthma reviews, inhaler technique checks and asthma management plans prevent asthma exacerbations STUDY DESIGN AND METHODS: This is a retrospective chart review using UK primary-care medical records between 2004-2021, linked to hospital records. Children were eligible from asthma diagnosis until aged 16 years. Annual implementation of asthma review, inhaler technique check, management plan was measured. Risk factors for them not being undertaken were determined using multivariable logistic regression. Self-controlled case series (SCCS) was adopted to assess the effectiveness of each activity over 12-months; this was divided into two 6-month periods.

Results: 126,483 children were eligible; 30-45% received each annual activity, 8% received all three together. Risk factors for not receiving activities included younger age, more socioeconomic deprivation, higher or no BMI measurement. Management plans and asthma reviews, as standalone activities, were associated with approximately 15% exacerbation reduction over 12-months and 8% over 6-months, respectively (management plan, N=4,624; 0-6 months (IRR, 95%CI): 0.87, 0.79-0.96; 6-12 months: 0.83, 0.73-0.95; asthma review, N=6,948; 0-6 months: 0.92, 0.85-0.99; 6-12 months: 0.93, 0.83-1.03). Standalone inhaler technique checks were not associated with exacerbations. Provision of all activities together was associated with approximately 30% exacerbation reduction over 12-months (N=3,643, 0-6 months: 0.76, 0.68-0.85; 6-12 months: 0.69, 0.60-0.81).

Interpretation: Most UK children do not receive the guideline-recommended activities to monitor their asthma. This study suggests, if implemented, they are effective in clinical practice and maximally effective when combined in the same visit.