No national audit of acute asthma in secondary care has been undertaken since 1991 in spite of further revisions of national guidelines. There has been no audit of the patient course through the ambulance, accident and emergency units (A&E), medical admission units (MEAU) and in-patient care in an integrated manner.

To audit the care of acute asthma in the various areas of secondary care in all hospitals in Wales in February 2006.

Standardised audit forms were produced to assess ambulance performance during transfer, A&E and MEAU care and in-patient care where admission occurred. The results were compared to national guidelines.

Acute asthma in Wales is a common reason for hospital attendance, 30% of such patients appear to be mild but 19% are severe/acute severe. British Thoracic Society (BTS)/Sign assessment of severity is rarely performed and both monitoring of progress and the discharge process are disappointing. There are major incompatibilities between BTS/Sign guidelines and the current Welsh Ambulance Service protocol. A similar problem exists with the British Society of Accident and Emergency Medicine (BAEM) protocol for moderate asthma.

This audit demonstrates disappointing adherence to BTS/Sign guidelines for the care of acute asthma. A new approach to acute asthma care in Wales is required.