Asthma prescribing and reattendance in Emergency Care in a London District Hospital

<bold>Introduction:</bold> The Global Initiative for Asthma (GINA) released 2022 guidelines stating that inhaled corticosteroid (ICS)-containing therapy should be initiated immediately once asthma is diagnosed as this reduces serious exacerbations and increases symptom control (GINA, Global Strategy for Asthma Management and Prevention, 2022). Short-acting beta-agonist (SABA) monotherapy is no longer recommended. BTS guidelines differ from GINA on when to initiate ICS therapy (BTS/SIGN, British guideline on the management of asthma, 2019). <bold>Aim:</bold> To review the pharmacotherapy and diagnosis of patients prescribed SABA inhalers in emergency care. <bold>Methods:</bold> Patients aged 18-40 who were prescribed a SABA inhaler from the Accident and Emergency (A&E) or Ambulatory Emergency Care (AEC) departments of a London hospital from December 2022 to July 2023 were analysed. Data was collected on reattendance, pre-existing asthma diagnoses, smoking, existing preventer therapy and preventer prescription on discharge. <bold>Results:</bold> 59% (105/179) were known asthmatics, and 20% (35/179) were current smokers, although 55% (99/179) had no smoking status recorded. Of the known asthmatics, 78% (82/105) had an ICS or no preventer inhaler. 18% (33/179) reattended A&E or AEC within 12 months, of which 79% (26/33) had a pre-existing asthma diagnosis. 69% of asthmatic reattenders (18/26) had an ICS or no preventer, and only 2/26 (11%) had their preventer escalated to a LABA/ICS. <bold>Conclusion:</bold> SABA monotherapy is still commonly prescribed despite updated GINA guidelines. Evidence-based prescribing may reduce reattendance. Smoking status was poorly recorded. The authors plan to introduce local asthma prescribing guidelines and mandatory smoking assessment.