Approximately 1 in 11 children have asthma in the UK. The key goals of asthma care are to achieve and maintain control of symptoms (shortness of breath, cough, chest tightness and wheeze), maintain normal activity levels, and to prevent asthma attacks and death from asthma. Most asthma studies have focussed on patients with more severe asthma. However, the greatest societal and healthcare burden lies with the majority of people which are those with milder asthma. Patients with milder asthma are collectively responsible for substantial healthcare costs, loss in productivity, and, concerningly, are at the greatest risk of dying from their asthma. Over 95% of asthma is managed solely in primary care. We need to improve routine asthma management in primary care. Currently, we do not know how often guideline-recommended interventions are implemented in children or how this compared to adults. Nor have we addressed the likely demographic and clinical inequalities associated with determining which patients receive them. We also do not know how clinically and cost effective these interventions in real life primary care clinical practice are in improving asthma symptoms and reducing the risk of asthma attacks.
This study will use nationally representative primary care medical records of school-age children to address the incidence, distribution, and effectiveness of annual asthma reviews, asthma management plans, inhaler technique checks and influenza vaccinations. First, we will describe the population, their management and exacerbation risk, using age at diagnosis. Next, annual incidence will be calculated for each intervention. Logistic regression models will be used to determine the association between multiple variables and receiving the intervention. Propensity methodology and self-controlled case series will be used to assess the effectiveness of each intervention. Cost effectiveness for each intervention will also be calculated using 2019 costs.
Incidence, distribution and effectiveness (asthma attacks, asthma control and cost) of guideline-recommended interventions
Chloe Bloom - Chief Investigator - Imperial College London
Chloe Bloom - Corresponding Applicant - Imperial College London
Mark Cunningham - Collaborator - Imperial College London
Sejal Saglani - Collaborator - Imperial College London
Zainab Khalaf - Collaborator - Imperial College London
HES Accident and Emergency;HES Admitted Patient Care;HES Outpatient;ONS Death Registration Data;Patient Level Index of Multiple Deprivation