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Symptomatic asthma: attendance and prescribing in general practice
1Department of General Practice and Primary Care, Guy's, King's and St Thomas' School of Medicine, Weston Education Centre, London, UK. dnolan@rcsi.ie
Respiratory Medicine
|February 28, 2002
Summary
Asthma management in primary care shows high steroid prescribing and attendance, yet many patients remain symptomatic. Under-treatment and low attendance are unlikely causes for persistent asthma symptoms.
Area of Science:
- Primary Care Medicine
- Respiratory Medicine
- Clinical Pharmacy
Background:
- Ongoing asthma symptoms persist in primary care despite increased prescribing and structured care.
- Under-prescribing and low patient attendance are often cited as reasons for uncontrolled asthma.
Purpose of the Study:
- To investigate the relationship between continuing asthma morbidity and patient attendance and prescribing patterns in primary care.
- To identify factors contributing to persistent asthma symptoms in patients managed in primary care settings.
Main Methods:
- A random sample of 402 subjects reporting frequent asthma symptoms were identified via a validated questionnaire.
- General practice case notes of 308 patients were analyzed for a 2-year period (1 year before and 1 year after questionnaire response).
- Data collected included patient attendance, asthma-related consultations, medication prescribing (inhaled steroids, oral steroids), and elements of structured care.
Main Results:
- 94% of symptomatic asthma patients attended primary care, with 77% having asthma-related consultations.
- Inhaled steroids were prescribed for 78% of patients, with 38% receiving high doses.
- Metered dose inhalers (MDIs) were prescribed for 86%, often in combination with other devices.
Conclusions:
- Asthma management in the majority of patients studied was active, with high levels of steroid prescribing.
- Despite high treatment intensity, many patients remained symptomatic, suggesting potential for improved care structure.
- Persistent symptoms in some patients may not be due to under-treatment or low attendance, indicating a need for further research into management strategies.