Recent asthma guidelines, what are the implications for patient management?

Recent publications in particular the British Thoracic Society guidelines for the management of adult asthma, recommend that bronchodilators should not be used more than once a day without anti-inflammatory treatment. There have not been any studies to determine what effect the implementation of these recommendations will have on our management of asthmatic patients. In this study 110 asthmatics who were using regular asthma treatment were identified. Thirty eight (34.5%) were using inhaled beta-agonists alone, of whom 11 (29%) required them more than once day for the relief of symptoms. Seventy two (65%) were using an inhaled anti-inflammatory agent plus an inhaled beta-agonist, of whom 38 (53%) were using their inhaled beta-agonist more than once per day. Forty-nine subjects (45%) therefore required a change in their management as their inhaled beta agonist use exceeded once a day. They were subsequently managed according to a treatment protocol based on current asthma guidelines and followed up over a three-month period. Twenty-eight of these (57%) required a change in their current therapy comprising of the addition of or an increased dose of their existing inhaled anti-inflammatory medication. Seventeen (34.6%) did not require a change in their current therapy, rather they required advice re: the proper use of their "preventitive" medication, or the introduction of a large volume spacer device. Four (8%) were on maximum therapy and no further intervention was possible. Forty-one (83.6%) reduced their inhaled beta agonist requirements to once or less per day within the study period.