Management of acute asthma: gaps between opinion and recorded action by general practitioners

To describe the mismatch between general practitioners' recorded actions and opinions in the management of acute asthma.

A comparison between clinical record data and questionnaire data on the ideal management of acute asthma.

The after-hours medical centre (AMC)--a service run by nearly all general practitioners in the Wellington region of New Zealand.

Sixty general practitioners working at the AMC, treating 266 patients with acute asthma over a two-month period.

A mismatch of over 40 percent occurred for pulse rate, respiratory rate, peak expiratory flow rate, modification of inhaled bronchodilators, and steroids, the use of nebulised medication and oral steroids. Other mismatches of interest to participating general practitioners were the prescribing of antibiotics for asthma, the difference in clinical behaviour between adults and children and the use of verbal action plans in asthma management. There was no mismatch for the recording of wheeze on auscultation in children, increasing inhaled asthma relieving drugs in adults, not using X-rays, not injecting asthma drugs, and not referring to hospital for most acute asthma.

The mismatches created "gaps" between opinion and action which had face validity to participating general practitioners. The findings indicate the need for implementation of guidelines and for more research to explain how the mismatches arise.