Filter by topic
Filter by content type
  1. Home
  2. Work we do
  3. State of Child Health

State of Child Health 2026: Asthma

Health Policy team
Save as PDF
This indicator measures the rate of emergency admissions to hospital due to asthma in children and young people in Scotland and England, measured per 100,000 population. There are no comparable data available for Wales and Northern Ireland.
Last updated
Post date
14 July 2026
Table of contents
Contents

This is one of 12 indicators in our State of Child Health resource.

What is the problem?

Asthma is a common condition, affecting approximately 1 in 11 children and young people in the UK.1 It is among the leading causes of emergency admission to hospital for children and young people in the UK.2 Since the first State of Child Health was published in 2017, emergency admission rates due to asthma had been declining, but progress has reversed in the last couple of years.

In England, this emergency admission rates had decreased from 217.1 admissions per 100,000 in 2014-15 to 122.2 in 2022-23, before increasing to 147.9 in 2023-24.

See chart in full

Similarly, in Scotland, admissions decreased from 181.6 per 100,000 in 2014-15 to 115.7 in 2022-23, before increasing to 157.4 in 2024-25.

See chart in full

Inequalities play a significant role in exacerbating these admission rates. Children and young people living in areas of higher deprivation are less likely to undergo annual asthma reviews3 and are more likely to experience poorly controlled asthma, attend emergency departments and require acute admissions.4

As a result, they have worse asthma-related outcomes, including a higher rate of admission to intensive care and higher mortality rates, compared with children living in the least deprived areas.5 Inequalities are also evident between different ethnic groups. Children and young people from Black, Asian and minority ethnic backgrounds are more likely to experience higher rates of uncontrolled asthma and hospitalisation compared with White British children.6

Why does it matter?

The majority of child deaths from asthma are preventable. In England, 54 children died as a result of an asthma exacerbation between April 2019 and March 2023 in England. The UK has one of the highest asthma-related mortality rates in Europe, and rates are four times higher in children from deprived backgrounds than amongst their wealthier peers.7

There are also substantial costs to the healthcare associated with managing poorly controlled asthma, as well as the indirect costs incurred from time off work for parents and carers and the educational cost of time off school.8

Drivers of poor outcomes

Evidence suggests that asthma-related hospitalisations have reduced as levels of air pollution in the area fall, and this effect is most significant for children living in areas of higher deprivation, where air pollution is usually highest.9 This was highlighted in England by the sharp fall in admissions from 76 in 2019 to 46 per 100,000 population in 2020, as significantly less vehicles were on the road during the COVID-19 pandemic.10 All children and young people who died due to an asthma exacerbation were likely exposed to air pollution levels above WHO guidelines (PM 5 µg/m3) but below the UK guidance (PM 20 µg/m3).7  Air quality in the home is also a contributing factor, with wood burners as well as overcrowding, mould and exposure to second-hand tobacco smoke, all contributing to poorer outcomes.11 Poor indoor air quality is increasingly recognised as a significant and often under-monitored risk factor for asthma exacerbations, particularly in deprived households where ventilation may be limited.

Other drivers of emergency admission include primary care capacity. Among those who died, 87% had been dispensed three or more reliever inhalers in the preceding year, indicating poor asthma control and an increased risk of acute exacerbations and death.7 Research shows that in 2024, GPs in deprived areas were responsible for 2,450 patients each, over 300 more than GPs in less deprived areas.12 Therefore, children and young people living in areas of higher deprivation are less likely to have regular asthma reviews where over-reliance on relievers could be identified.

The variation in knowledge and training in asthma management amongst healthcare staff has also been identified as a modifiable factor in poor asthma outcomes and asthma deaths, which led to the introduction of the national capabilities framework for professionals who care for children and young people with asthma.13

Why we need to act now

Without immediate action, the trend of increasing emergency admissions to hospital will persist, leading to more avoidable deaths. Poorly controlled asthma costs the NHS 22% more than well-controlled asthma,14 and implementing these recommendations would not only save lives, but also support a shift towards more community-based care, in line with the 10 Year Health Plan for England, published in 2025. This would deliver significant financial savings.

A paediatrician's insight

From Dr Michael McKean, Consultant in Respiratory Paediatrics and RCPCH Vice President for Policy

Your experience of supporting and/or treating children and young people who require emergency admission due to asthma - has anything changed over time?

"As a respiratory paediatrician, I now tend to only see those asthmatics with very severe or recurrent episodes requiring hospital admission. Whilst we are using a wider array of medications to treat exacerbations, such as dry-powdered devices, there are sadly still too many children coming into hospital with asthma. This hasn’t changed!

"One very significant change is that we now have a greater understanding of environmental drivers. Indoor and outdoor air quality are both now widely recognised as major contributors to asthma. Asking about the air children breathe is becoming a routine part of taking an asthma history, though we are a long way from achieving clean air for our kids."

What have been the challenges to supporting children and young people in this space - what contributes to this or keeps them returning to NHS for support?

"Asthma is a complex disorder that includes inflammation triggered by viruses, allergens, mould and pollution, etc. Management can therefore be difficult: taking preventative treatment when well can be tricky, and care plans are not always consistently followed. Poor concordance adds to the rising problems faced by CYP living in polluted areas and in poor housing.

"There are also social and psychological issues at play. Children admitted with severe asthma are often frightened of recurrence, as are their parents, and the resulting anxiety itself worsens symptoms. Asthma affects children in multiple settings — homes, schools, play areas —meaning many different adults are responsible for their care, which can be fragmented.

"A ‘one-dimensional’ view of asthma misses the factors that lead to a severe episode, and often unfairly places responsibility on parents.  I often get frustrated that so many adults are involved, yet the child’s asthma remains unstable. Our systems of care are separated, and we don’t know who to speak with to wrap better support around a child and their family: health, social care, or, most importantly, schools and nurseries.

"I recall a young asthmatic with six attendances to the emergency department whose family lived in relative poverty and a very smoky environment. It wasn’t until we identified targeted, council-led support in their estate and connected them to local smoking reduction services that reinforced the education around treatment, that symptoms started to improve. This type of ‘social prescribing’ can address these factors beyond the reach of hospital care. These connections need to become part of our future way of working for children with chronic diseases such as asthma."

Any examples of good practice to tackle the growing rates of emergency admissions due to asthma?

"Over my 25 years as a consultant, I’ve seen many initiatives come and go, as well as leading a few myself! Most have had limited impact, but one I was especially proud of was the Beat Asthma programme, developed by my good colleague Dr Jen Townshend.

"It is a whole-system framework that works, focusing on education and support for professionals, parents and children. When implemented, the framework reduced asthma admissions by 25%. It is now one of the resources that underpins the NHS England framework for asthma care, providing education for schools, sports and other clubs, as well as for all levels of community and hospital healthcare. Have look yourself: Beat Asthma."

Any advice you'd give to paediatricians that would help prevent emergency admissions due to asthma?

"Yes! Six key steps:

  1. Take a good history: Don’t forget the social context and the environment.
  2. Check medication use: Utilise the increasing ability to see primary care records; see how many inhalers are being issued as it can be a useful indicator to understanding concordance with treatment and may also show potential over reliance on salbutamol).
  3. Prevention is better than cure: Identify the triggers, and then get busy. Create a network with the GP and, if possible, the school. Think about smoke cessation and be aware of vaping and the problems it is now causing.
  4. Inhaler technique: Make sure the child can take their inhalers correctly! There will be a friendly respiratory nurse, or paediatrician somewhere in your local network that can assist if you don’t know how to yourself.
  5. Provide a personalised asthma plan: This is more complex with MART, AIR, as well as spacers/MDIs. If your unfamiliar, refer to resource on the Beat Asthma website!
  6. Finally advocate for clean air: Pollution disproportionately affects children, and the UK has yet to meet WHO air quality recommendations. Collective advocacy is essential to drive change. Health professionals can use one of our handy web toolkits to support them to do this – we have both an Air Pollution Companion and a Greener Paediatrics Toolkit. "

Recommendations

England
  • Enact a Clean Air Act to establish a legal right to clean air in all four nations of the UK.
  • Meet the 2005 WHO Air Quality Guidelines for PM2.5 by 2030, and develop a clear strategy to meet the 2021 WHO Air Quality Guidelines.
  • Ensure every child and young person with asthma has a Personalised Asthma Action Plan (NHS).
  • As part of a funded, long-term child health workforce strategy, increase investment in primary care capacity, with a focus on areas of socioeconomic deprivation, to ensure the workforce is able to meet national asthma care standards. 
Scotland
  • Reduce children’s exposure to traffic-related air pollution, including by expanding Low Emission Zones (LEZs) to more towns and cities, strengthening existing schemes, tackling vehicle idling —particularly around schools—through stronger enforcement and school street initiatives, and accelerating the transition to cleaner public transport, including electric buses and trains. 
  • Strengthen air quality monitoring and alert systems, with a focus on children’s settings, including expanding monitoring in and around schools, nurseries and healthcare settings, and introducing real time alerts for high pollution episodes to enable schools, NHS services and families to act.
  • Improve air quality by tackling emissions from domestic wood burning, including through public awareness campaigns, restrictions on new stoves, and support for cleaner heating alternatives.
Wales
  • Ensure every child with asthma has a Personalised Asthma Action Plan (PAAP).
  • Expand the number of smoke-free and vape-free places in areas where children are likely to be present and ensure effective enforcement by local authorities.
  • Invest in preventative health measures to reduce inequalities, including implementing the Environment (Air Quality and Soundscapes) (Wales) Act 2024, and addressing poor housing conditions.  
Northern Ireland
  • Join the National Asthma and COPD Audit Programme (NACAP) or publish equivalent regional data, with action planning requirements aligned to England, Scotland and Wales. 
  • Strengthen primary care asthma pathways in line with updated Healthy Child, Healthy Future early intervention priorities, embedding asthma education and inhaler technique checks within routine school nurse and health visitor contacts.
  • Establish Northern Ireland-wide reporting of childhood asthma emergency admissions.

This is one of 12 indicators in our State of Child Health resource.