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Objective: To report 8 years' data from a UK-wide audit of acute wheeze/asthma management in children carried out annually since 1998. Design: Paediatricians were invited to complete a simple form based on British Thoracic Society (BTS) asthma guidelines for any child over 1 year of age admitted with acute wheeze/asthma each November from 1998 to 2005. Information was collected about patient demographics, initial hospital severity assessment, in-hospital treatment, asthma education and emergency planning, discharge treatment and follow-up. Results: Data on 9429 admissions were available, with between 53 and 67 centres participating each year. The majority of children were under 5 years of age (median age 3 years). Nearly all were treated with bronchodilators, and around 90% received systemic steroids. Vital signs (pulse and respiratory rate) and oxygen saturation on admission remained stable over the audit period. However, the proportion of admitted children given bronchodilators exclusively by spacer increased from 7% to 44% between 1998 and 2005. The proportion discharged with written asthma plans increased from 24% to 41%. Wide variations were noted between centres in the proportions of children receiving chest x rays and written asthma plans. Children admitted under the care of a respiratory specialist were more likely to have documentation that they had been given written asthma information and a written asthma plan and had had their inhaler device technique checked than if under the care of a general paediatrician. Conclusions: In many areas, hospital treatment closely followed published guidance. However, some important deficiencies were noted and variations remain. As well as monitoring guideline implementation, national audit can highlight opportunities for research and improving care locally and nationally. [ABSTRACT FROM AUTHOR]

Objective: To determine, in prematurely born children who had bronchopulmonary dysplasia (BPD), if respiratory morbidity, healthcare utilisation, and cost of care during the preschool years were influenced by use of supplementary oxygen at home after discharge from the neonatal intensive care unit. Design: Observational study. Setting: Four tertiary neonatal intensive care units. Patients: 190 children, median gestational age 27 weeks (range 22–31), 70 of whom received supplementary oxygen when discharged home. Interventions: Review of hospital and general practitioner records together with a parent completed respiratory questionnaire. Main outcome measures: Healthcare utilisation, cost of care, cough, wheeze, and use of an inhaler. Results: Seventy children had supplementary oxygen at home (home oxygen group), but only one had a continuous requirement for home oxygen beyond 2 years of age. There were no significant differences in the gestational age or birth weight of the home oxygen group compared with the rest of the cohort. However, between 2 and 4 years of age inclusive, the home oxygen group had more outpatient attendances (p = 0.0021) and specialist attendances (p = 0.0023), and, for respiratory problems, required more prescriptions (p<0.0001). Their total cost of care was higher (p<0.0001). In addition, more of the home oxygen group wheezed more than once a week (p = 0.0486) and were more likely to use on inhaler (p<0.0001). Conclusions: Children with BPD who have supplementary oxygen at home after discharge have increased respiratory morbidity and healthcare utilisation in the preschool years. [ABSTRACT FROM AUTHOR]

Background: In prematurely born infants with chronic lung disease (CLD), RSV hospitalisation is associated with increased health service utilisation and costs in the first two years after birth. Aims: To determine whether RSV hospitalisation in the first two years was associated with chronic respiratory morbidity during the preschool years in prematurely born children who had had CD. Methods: Retrospective review of readmissions, outpatient attendances, and community care in years 2-4 and, at age 5 years, assessment of the children's respiratory status and their health related quality of life. Comparison was made of the results of children who had had at least one hospitalisation in the first two years after birth for RSV infection (RSV group) to those of the rest of the cohort. Participants were 190 of an original cohort of 235 infants with CLD and a median gestational age 27 (range 22-33) weeks. Results: The 33 children in the RSV group, compared to the rest of the cohort, had a greater duration of hospital stay and more outpatient appointments. The RSV group had required more prescriptions for all treatments and respiratory medications, and more had used an inhaler. The cost of care of the RSV group was higher (median £2630 [€4000, US$4800], range £1 24-18 091 versus £1360 [€2500, US$3000], range £5-18 929) and their health related quality of life was lower. Conclusion: In prematurely born children who had developed CLD, RSV hospitalisation in the first two years was associated with chronic respiratory morbidity and increased cost of care. [ABSTRACT FROM AUTHOR]

Aims-To compare the use of health care resources and associated costs between infants with chronic lung disease (CLD) who had or had not an admission with a proven respiratory syncytial virus (RSV) infection. Methods-Review of community care, outpatient attendances, and read missions in the first two years after birth. Patients: 235 infants (median gestational age 27 weeks) evaluated in four groups: 45 infants with a proven RSV admission (RSV proven); 24 with a probable bronchiolitis admission; 60 with other respiratory admissions; and 106 with non-respiratory or no admissions. Results-The RSV proven compared to the other groups required more frequent and longer admissions to general paediatric wards and intensive care units, more outpatient attendances and GP consultations for respiratory related disorders, and had a higher total cost of care. Conclusion-RSV hospitalisation in patients with CLD is associated with increased health service utilisation and costs in the first two years after birth. [ABSTRACT FROM AUTHOR]

Comments on several issues related to health services in Great Britain. Importance of eye protectors on reducing facial injuries; Use of home nebulizers by children with asthma; Effects of hormone therapy in general practice.