• mortality
• adolescent health
• data collection

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 …