BACKGROUND Guidelines advise minimising asthma exacerbation risk is achieved partially through good clinical practice activities, including scheduled asthma reviews, inhaler technique checks and asthma management plans. We assessed how frequently these activities are provided and how effective they are in clinical practice. RESEARCH QUESTION Do guidelines-recommended activities such as asthma reviews, inhaler technique checks and asthma management plans prevent asthma exacerbations STUDY DESIGN AND METHODS: This is a retrospective chart review using UK primary-care medical records between 2004-2021, linked to hospital records. Children were eligible from asthma diagnosis until aged 16 years. Annual implementation of asthma review, inhaler technique check, management plan was measured. Risk factors for them not being undertaken were determined using multivariable logistic regression. Self-controlled case series (SCCS) was adopted to assess the effectiveness of each activity over 12-months; this was divided into two 6-month periods. RESULTS 126,483 children were eligible; 30-45% received each annual activity, 8% received all three together. Risk factors for not receiving activities included younger age, more socioeconomic deprivation, higher or no BMI measurement. Management plans and asthma reviews, as standalone activities, were associated with approximately 15% exacerbation reduction over 12-months and 8% over 6-months, respectively (management plan, N=4,624; 0-6 months (IRR, 95%CI): 0.87, 0.79-0.96; 6-12 months: 0.83, 0.73-0.95; asthma review, N=6,948; 0-6 months: 0.92, 0.85-0.99; 6-12 months: 0.93, 0.83-1.03). Standalone inhaler technique checks were not associated with exacerbations. Provision of all activities together was associated with approximately 30% exacerbation reduction over 12-months (N=3,643, 0-6 months: 0.76, 0.68-0.85; 6-12 months: 0.69, 0.60-0.81). INTERPRETATION Most UK children do not receive the guideline-recommended activities to monitor their asthma. This study suggests, if implemented, they are effective in clinical practice and maximally effective when combined in the same visit.

中文翻译：

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指南推荐的哮喘儿童临床活动的实施和有效性：基于人群的队列。


背景 指南建议，部分通过良好的临床实践活动实现将哮喘恶化风险降至最低，包括定期哮喘审查、吸入器技术检查和哮喘管理计划。我们评估了提供这些活动的频率以及它们在临床实践中的有效性。研究问题 指南推荐的活动，如哮喘审查、吸入器技术检查和哮喘管理计划，是否能预防哮喘恶化 研究设计和方法： 这是一项回顾性图表回顾，使用 2004-2021 年间的英国初级保健医疗记录，与医院记录相关联。儿童在 16 岁之前符合哮喘诊断条件。每年实施哮喘审查、吸入器技术检查、衡量管理计划。使用多变量 logistic 回归确定未进行这些实验的危险因素。采用自我对照病例系列 （SCCS） 来评估每项活动在 12 个月内的有效性;这分为两个 6 个月期间。结果 126,483 名儿童符合条件;30-45% 的人收到了每项年度活动，8% 的人同时收到了这三项活动。不接受活动的危险因素包括年龄较小、社会经济剥夺程度较高、BMI 测量较高或没有。管理计划和哮喘评价作为独立活动，分别与 12 个月和 6 个月急性发作减少约 15% 和 8% 相关（管理计划，N=4,624;0-6 个月（IRR，95%CI）：0.87、0.79-0.96;6-12 个月：0.83、0.73-0.95;哮喘回顾，N=6,948;0-6 个月：0.92、0.85-0.99;6-12 个月：0.93、0.83-1.03）。独立的吸入器技术检查与急性加重无关。 在 12 个月内，提供所有活动与大约 30% 的恶化减少相关 （N=3,643,0-6 个月：0.76,0.68-0.85;6-12 个月：0.69,0.60-0.81）。解释 大多数英国儿童没有接受指南推荐的哮喘监测活动。这项研究表明，如果实施，它们在临床实践中是有效的，并且在同一次就诊中结合使用时效果最佳。