[Bronchial asthma--expectations and concepts of general practitioners]

Discrepancies between asthma management in general practice and national as well as international guidelines and recommendations are currently not fully explained. Subjective conceptions, ideas and beliefs are likely to be as important as factual knowledge when physicians decide how to treat their patients. Our study is part of the European Drug Education Project, an international project promoting rational pharmacotherapy in 5 European countries. Interviews on asthma and its treatment were conducted with 20 general practitioners in Germany, emphasizing beliefs and ideas on the disease and its origins as well as treatment goals and options rather than factual knowledge. Qualitative analysis was performed using a phenomenographic approach. Phenomenography aims at describing "subjective" reality, as it is conceived by people to understand learning and reflection processes. Even though most physicians know the treatment recommendations for asthma, adherence is variable. Reasons can be found in the variability of disease conceptions, often emphasizing psychosomatic or patient-centered aspects. The importance of individual treatment goals and experience of the doctor-patient relationship in a general practice setting is highlighted. Uneasiness concerning specialist recommendations on disease management and pharmacotherapy are commonly expressed. There are considerable variations in the physicians' conceptions on asthma and its management. Understanding these attitudes can provide a rational basis for the development of guidelines and implementation strategies corresponding to the needs of primary care physicians.