Acute asthma exacerbations remain a major cause of hospital admissions., British Thoracic Society (BTS) asthma guidelines recommend that all patients admitted to the hospital with an exacerbation should be followed up within 6 months. In the United Kingdom, this follow-up is commonly performed in medical clinics by consultant doctors or, frequently, by doctors in training. The purpose of the follow-up consultation is to review the diagnosis, ensure optimization of medical treatment, and to identify and if possible eliminate factors that gave rise to the hospital admission. other
However, several studies have suggested that social and compliance issues are important in patients with poor asthma control. These issues are now increasingly addressed by respiratory nurse specialists. Hospital education, self-management, and outreach programs for asthma are now routinely conducted by nurse specialists, but some uncertainty remains over their long-term effectiveness. In general practice, nurse specialists can significantly reduce asthma morbidity with nurse-led asthma clinics. Although hospital outpatient clinics conducted by nurse specialists are increasing in frequency, their effectiveness has not been evaluated. We wanted to examine the role of the respiratory nurse specialist in this setting and to compare clinical outcomes with patients managed by a respiratory consultant (doctor)
In 1996, a respiratory doctor follow-up clinic was set up at West Suffolk Hospital NHS Trust, which offered a follow-up clinic to all adult patients admitted with an acute asthma exacerbation to be seen within 2 weeks of hospital discharge. This reduced the readmission rate to the hospital. To increase the extent of this service, a nurse specialist also conducted these clinics. In 1999, a pilot study of 85 patients was conducted to assess whether this clinic could safely be run by a respiratory nurse specialist alone. The study found that the readmission rate at 6 months was 4% in the physician patient group compared to 6% in the nurse specialist group. However, this pilot study was not sufficiently powered to show a small difference in exacerbation rate, readmission rate, or quality of life between the two groups. Therefore, a larger, randomized controlled trial was needed. The aim was to assess whether follow-up by a nurse specialist following an acute asthma admission was as effective as that by a respiratory doctor. Follow-up in the study was for a 6-month period.