Child with asthma.

Management of chronic asthma in children aged 16 years and under

HSIB legacy content

HSIB legacy content

This investigation was carried out by the Healthcare Safety Investigation Branch (HSIB). Find out more about HSIB legacy.

National investigation

Asthma is the most common lung disease in the UK. 1.1 million children are diagnosed with the condition.

Our investigation looked at the risks involved in the management of children aged 16 years and under diagnosed with asthma. Diagnosis and the management of asthma, particularly in children and young people, can be complex. It is important to get it right, as otherwise significant harm or death can result.

Asthma is a long-term condition that is characterised by chronic airway inflammation (swelling). Symptoms include breathlessness, wheeze, cough and tightness of the chest. Acute asthma attacks can be fatal. In 2018, more than 1,400 adults and children died from asthma attacks in England and Wales, an 8% increase compared to 2017. Preventable death is a significant issue.

From infancy to the teenage years there are age-specific challenges. These challenges include both underdiagnosis (where asthma is present but not diagnosed or treated) and overdiagnosis (where asthma is diagnosed but the patient is unlikely to experience symptoms or problems).

Formal diagnosis of the condition in under five year olds can be challenging. The symptoms of asthma can be confused with those of other respiratory diseases and young children are usually unable to perform lung function tests. Diagnosis is reliant on close monitoring of symptom control in response to treatment. In children over five years, appropriate tests can usually be used to help diagnose asthma.

The effectiveness of asthma management is particularly challenging in those patients whose care fall between hospital and general practice, where responsibility for monitoring the condition is not clearly defined.

Reference event

The investigation was launched after HSIB identified an event involving a 5 year old child. The child had numerous planned and unplanned (emergency) attendances at hospital with respiratory symptoms, before suffering a near fatal asthma attack. Prior to the event, the child had no formal diagnosis of asthma and issues had been identified (but not resolved) regarding adherence to treatment.

Investigation summary

This investigation:

  • Drew on the field of human factors to understand the barriers for timely diagnosis and adherence with treatment plans.
  • Sought to identify the risks associated with a lack of clarity regarding oversight of ongoing care in a complex patient, and how these could be mitigated. This spans different care settings.
  • Examined mechanisms of sharing clinical information between healthcare sectors.