In Scotland, rates were comparable to England & Wales and
showed a similar increase in all ages up to 1990. There has been
a downturn only in children, which occurred in the early 1990s,
later than in England and Wales.
Changes in coding and information systems are unlikely to explain
these trends. Hospital admissions can vary due to changes in medical
practice or patient behaviour. Other studies have shown that the
rising trend in admissions was not due to an increase in re-admission
rates or diagnostic transfer from related conditions. Admission
rates could also reflect changes in underlying morbidity. This
can relate to the prevalence of asthma itself or the prevalence
or severity of asthma exacerbations. There is evidence from general
practice of fewer asthma attacks (factsheet 2000/1) and also evidence
that suggests patients are being prescribed more medication, both
of which would correspond to this explanation (factsheet 99/1).
The underlying prevalence of asthma may have also increased, but
little is known about trends in UK prevalence through the 1990s.
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