If it's 'only' asthma, why are children still dying?

Outcomes for children with asthma in the UK continue to lag behind other European countries. Mortality remains unacceptably high and in contrast to adults with asthma, most deaths occur in the 1 in 20 children with asthma who have severe asthma. Despite evidence that children with asthma have better outcomes with subspecialist care, many children with severe asthma are not referred onwards and barriers exist at every level of the UK healthcare system. The National Review of Asthma Deaths (NRAD) recommended that specialist review should be requested if there had been three or more courses of oral steroids, two or more visits to accident and emergency or an admission to hospital. This review reports the results of a recent interview study of 126 healthcare professionals. More than half of general practitioners (n=49) reported adopting a higher threshold than this. General paediatricians (n=47) set a higher bar still. Their median thresholds for referral to a subspecialist asthma clinic were 4 courses of oral steroids, 3 hospital admissions and 30 days off school in the previous year. This review offers a simple working definition of severe asthma based on current national and international guidelines and provides an example of the recently adopted referral criteria to paediatric severe asthma clinics in the West Midlands.