[Treatment of asthma--an analysis of clinical judgment among general practitioners]

The asthma patient's symptoms, use of drugs, and peak expiratory flow rates dictate treatment of asthma according to the guidelines. Our aim was to examine which information influenced the decisions of general practitioners.

Out of 100 general practitioners attending a course on asthma management, 75 responded to several constructed patient cases on asthma treatment. They decided whether or not to give oral steroids in case of an acute exacerbation and judged the quality of pharmacological treatment. Age, symptoms, body temperature, peak expiratory flow measurement and the dose of beta-2 agonists and inhaled steroids varied from patient to patient. Their attitudes to the use of oral steroids and to the usefulness of measuring peak expiratory flow were evaluated.

Among the doctors, 52% evaluated only one characteristic of the patients when deciding upon treatment with oral steroids. The use of drugs was evaluated by one quarter of the doctors when they judged the quality of treatment. Respectively, 81% and 73% were influenced by objective measurements in these decisions. The majority of doctors applied oral steroids and measured peak expiratory flow in asthmatics.

This study indicates that general practitioners focus mainly on measured peak expiratory flow rate. The patient's symptoms ought to be given more consideration in the treatment of asthma. The patient's use of anti-asthmatics is emphasised in guidelines, but was of only limited importance to the doctors in this study.