The BTS and SIGN guideline on the management of asthma says: “Acute asthma attacks should be considered a failure of preventive therapy and thought should be given about how to help families avoid further severe episodes.”8

The BTS developed the asthma care bundle for patients (adults and children older than 2 years) discharged from A&E after an acute asthma attack, or who have been admitted to hospital. It has five core components, all of which should be completed to achieve the best outcome:14

·      inhaler technique assessment

·      medication review

·      providing a tailored written action plan for patient self-management

·      consideration of triggers and exacerbating features

·      appropriate follow-up.

Good medication adherence is important for asthma control as non-adherence to preventer therapies (mainly ICS) - whether intentional or non-intentional - frequently causes deterioration in asthma control.14

Common asthma triggers to check for include use of non-steroidal anti-inflammatory drugs (NSAIDs), smoking or exposure to smoke, pets and occupational factors.

People who have attended hospital or have been admitted due to an asthma flare-up should have a follow-up appointment in primary care soon after discharge, ideally within two days of leaving hospital. Referral for specialist care within two weeks should also be considered.