Peak flow was recorded as a percentage of predicted value or previous best recorded in the hospital, at first follow-up, and at 6 months. Patients were given a diary card for the 6-month follow-up to record twice-daily peak flow, any medication change, emergency treatment, or exacerbations. An exacerbation was defined as a drop in peak flow > 30% of predicted or best predicted, requiring any of the following: increased inhaled corticosteroids, emergency nebulization, or a course of oral corticosteroids. Details of any exacerbations were obtained from the patient diary card, attendance records in the emergency department, and general practice records. No inconsistencies were found. A few patients in the study had home nebulizers and were able to self-administer bronchodilators during an exacerbation. However the use of home nebulization was not being actively encouraged during the period of the study. Asthma medication was recorded at hospital discharge, at the 2-week follow-up, and at the 6-month follow-up. Data collection was performed by an independent research assistant who was unaware of the group to which the patient was allocated. Link
In addition, in a separate analysis, details of hospital appointments offered and whether the patient attended, cancelled, or did not attend (or indeed whether the clinic appointment was cancelled by the clinician) were obtained from the hospital information system. This outcome was included to assess whether type of professional seen had any impact on the likelihood of a patient attending the appointment.
Patients were asked to complete the Asthma Questionnaire 20 (AQ20) quality of life questionnaire and the St. George Respiratory Questionnaire (SGRQ) during hospital admission and at the 6-month assessment. The SGRQ has three dimensions: symptoms, activity, and impacts. These can be summed to give a total score (expressed as a percentage). High scores represent a poor quality of life. The AQ20 is a simpler, shortened version of the SGRQ. Comparison of the two questionnaires will be reported separately.
The primary outcome was to compare the number of acute exacerbations within 6 months of hospital discharge between the two groups. The change in peak flow as a percentage of predicted or previous best at 6 months and differences in quality of life were also evaluated. Four possible clinic outcomes were also compared between the groups: patient attended, patient cancelled, patient did not attend, or clinician cancelled.