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This review on childhood asthma focuses on acute and chronic management in relation to the asthma phenotypes reviewed in our previous article.1 It includes when to refer to hospital services and updates on new and emerging treatments.Managing asthma requires not only an understanding of specific treatments but also a commitment to supporting the child and family as they learn to deal with this long term illness. Key areas of management include acute asthma management plans, day to day "preventer" treatments, monitoring for side effects, and an emphasis on trying to achieve a normal level of functioning. For young children and those with atypical features, repeated review also provides an opportunity to revisit the diagnosis.

To objective of this project was to reduce unplanned hospital admission rates in children related to asthma to the Newcastle upon Tyne Hospitals National Health Service Trust (NUTH).Multiple educational interventions were introduced both locally and regionally including: a collection of educational materials aimed at young people and families, schools, primary care and secondary care on the website www.beatasthma.co.uk; regional training days; a nurse-led one-stop clinic; a new pathway following an acute attendance to hospital with an asthma attack; a local asthma service and cascade training for schools.The primary outcome measure was reduction in unplanned hospital admission rates in children due to asthma to the NUTH.Results showed that admission rates had been increasing at a sustained rate of approximately 30% each year in the 3 years prior to our intervention. After the Beating Regional Asthma Through Health Education interventions, unplanned admissions to NUTH reduced by 29% and this reduction has been sustained for the last 3 years. This compares with a regional increase of 10% over the same time period.In conclusion, simple but effective educational interventions resulted in a significant and sustained reduction in unplanned asthma admissions to NUTH. Further work is underway to extend the reach of these interventions into primary care and schools.

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IntroductionThe National Review of Asthma Deaths (NRAD) and British Thoracic Society (BTS) guidance highlight the importance of patients with asthma having a PAAP. From on-going local audit we know that over 90% of our clinic population are provided with a PAAP, which is updated on at least a yearly basis. However, we do not have data to inform us if the patients/carers use their plan appropriately.MethodA survey was conducted in a tertiary paediatric asthma clinic. The questionnaires were provided to parents and young adolescents with asthma whilst they were waiting for their appointment. There were specific yes/no and multiple choice questions as follows: location of paper plan, frequency of use, contacts and entities with access to plan, impression of unscheduled healthcare reduction and a direct question asking if digitalizing a personalised asthma plan would be useful.Results55 questionnaires were completed. All but 1 patient were able to identify that they had a PAAP. The majority of individuals considered their PAAP useful (90%) and they all found it easy to follow. 67% of patients looked at their PAAP on at least a monthly basis. 19 patients had not shared their PAAPs with other carers, whilst PAAPs had been shared with schools (30), grandparents (13) and childminder (2). Patients/carers perceived that knowledge of their PAAPs had helped to reduce unscheduled healthcare attendances (89%) and symptoms (49%); with 47% perceiving it had helped increase their peak expiratory flow rate (PEFR). 95% of all patients would prefer a PAAP in an electronic format.ConclusionIn tertiary paediatric asthma clinic patients and their carers have good knowledge of their PAAP, use them regularly and share them with other care givers. They perceive that they do help improve asthma control and reduce exacerbations. Families would prefer their PAAP in an electronic format.