Article Text

Download PDFPDF
Steroid-filled rant: or another fashion accessory?
  1. Andy Bush1,2,
  2. Mark Levy3,
  3. Louise Fleming1,2
  1. 1 Paediatric Respiratory Medicine, Royal Brompton and Harefield NHS Foundation Trust, London, Middx, UK
  2. 2 Respiratory Paediatrics, National Heart & Lung Institute, Imperial College London, London, UK
  3. 3 UK National Review of Asthma Deaths, London, UK
  1. Correspondence to Professor Andy Bush, Paediatric Respiratory Medicine, Royal Brompton and Harefield NHS Foundation Trust, London SW3 6NJ, UK; a.bush{at}

Statistics from

Few would deny that an asthma attack (not an ‘exacerbation’, an utterly feeble and inadequate word1) can be a really serious life-event. The strongest predictor of a severe or fatal asthma attack is a previous bad attack. Asthma attacks are associated with impaired trajectories of airway development and growth. Despite a positive Tsunami of guidelines, working parties, bundles, initiatives and many thousands of words, children still die of asthma in 21st century Britain;2 the challenge is to turn good intentions (and writing) into good practice, and in that we have largely failed. Preventable asthma attacks have been described as ‘never events’,1 a really serious failure of management which should provoke a focused response to prevent a potentially fatal recurrence. The postattack review (preferably within 48 hours of discharge from hospital or at the end of a course of steroids for attacks managed in the community), which is hardly ever performed (only 127/333 (<40%) attacks) had a postattack follow-up and only 32/127 (25%) of these were within 2 days.3 The review is an opportunity to examine all aspects of the child’s management, including triggers, adherence to inhaled corticosteroids (ICS) and use of short-acting β-2 agonists, using as a minimum prescription uptake. The asthma plan should also be reviewed in detail—was it followed and should it be altered?

The seriousness of asthma attacks is also recognised by attack frequency being built into International definitions of severe asthma1 and being a fundamental part of NICE requirements for expensive biologicals such as omalizumab and mepolizumab. Clearly, these biologicals are not indicated in children who do not have attacks, but the requirement for …

View Full Text


  • Contributors AB wrote the first draft. All authors read and edited it to produce the final version, which all authors agreed.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests ML reports personal fees from Clement Clarke International, personal fees from Teva, personal fees from Astra Zeneca, non-financial support and other from Global Initiative on Asthma (GINA), USA, personal fees from Chiesi, grants from Consorcio Ricerca in Futura, personal fees from Soar Beyond, personal fees from Orion Pharmaceuticals, other from Napp Pharmaceuticals, personal fees from National Services for Health Improvement, a company providing services for practices (Nurse asthma Reviews), personal fees from Novartis Pharmaceuticals, personal fees from GLaxo Smith Klein, non-financial support from Asthma and COPD (Joint) Lead for Whole Systems Integrated Care (WSIC) NorthWest London, personal fees from Trudel Pharmaceuticals, personal fees from AstraZeneca, outside the submitted work.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; internally peer reviewed.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.