A comparison of general and respiratory physicans' follow up arrangements post discharge after asthma exacerbations

Introduction: BTS guidelines recommend that patients admitted to hospital with acute asthma exacerbations receive a secondary care follow-up appointment about a month post discharge and that, as well as oral corticosteroid (OCS), inhaled corticosteroids (ICS) are started or continued at discharge. We postulated that, compared with those managed by general/acute physicians, patients admitted with acute asthma under respiratory specialists were more likely to receive timely follow up appointments and to be discharged on OCS/ICS. Method: We reviewed electronic records of all patients admitted to our trust with acute asthma in 2015, comparing those discharged by respiratory specialists with those discharged by general physicians with regards to outpatient follow-up and discharge on ICS/OCS. Results: We reviewed 141 admissions. 30 patients discharged from the Emergency Observation Ward were excluded. Complete records were available for 85 patients. 24 of the 53 non-respiratory admissions (45%) were followed up compared with 28 of the 32 respiratory admissions (87.5%). No patients managed by generalists and only 12(37.5%) of those managed by respiratory specialists were reviewed within 4 weeks. Mean (SD) time to follow up for non-respiratory was 11.7 (2.9) v 7.0 (4.8) weeks for respiratory. Only 4 (5%) patients did not attend appointments. All resp patients were discharged on ICS/OCS compared as were all but one (98%) non-respiratory admission. Conclusion: ICS prescription rates on discharge was near ubiquitous. Follow up appointments were more commonly organised by specialists and than those discharged under the care of general physicians, but few patients were seen within a month.