Thorax 1999;54:296-300 ( April )

Morbidity from asthma in relation to regular treatment: a community based study

L J Walsh,^a C A Wong,^a S Cooper,^a A R Guhan,^a M Pringle,^b A E Tattersfield^a

^a Division of Respiratory Medicine, City Hospital, Hucknall Road, Nottingham NG5 1PB, UK, ^b Department of General Practice, Queen's Medical Centre, Nottingham, UK

Correspondence to: Dr L J Walsh.

Received 24 March 1998; Returned to authors 28 July 1998; Revised version received 4 November 1998; Accepted for publication 1 December 1998

BACKGROUNDThe extent to which asthma morbidity in the community occurs in patients who are having relatively little treatment or in those on step 3 or above of the British asthma management guidelines is uncertain. We have looked at this in a community population in southern Nottinghamshire.
METHODSA cross sectional review of treatment in all patients over the age of four with diagnosed asthma was carried out in five large general practices (population 38 865) in 1995/6 using computerised general practice records. The patients' usual treatment was obtained from prescription data and categorised by the appropriate step on the British guidelines on asthma management. Two measures of morbidity, the request for 10 or more short acting  agonist inhalers a year or the need for a course of oral corticosteroids in the last year, were related to the regular treatment of the patients.
RESULTSOf the 3373 patients (8.7%) given a diagnosis of asthma, the percentage on steps 1, 2, 3, 4, and 5 of treatment were 54%, 22%, 11%, 3.6%, and 1%, respectively, with a further 8% having had no treatment. During the past year 13.6% had been prescribed 10 or more  agonist inhalers and 12.5% had received at least one course of oral corticosteroids. Both measures occurred more frequently in patients taking more prophylactic treatment (step 3 or above). Nevertheless, because most patients were on steps 1 and 2 of the treatment guidelines, more than half the patients requiring high doses of inhaled  agonists or a course of oral prednisolone came from those taking low dose or no regular inhaled corticosteroid.
CONCLUSIONSEvidence of morbidity from asthma was found in many patients taking little or no prophylactic medication and this should be amenable to improved education. A different approach may be needed for patients with continuing morbidity who are already taking higher doses of prophylactic medication.

Keywords: asthma; treatment; British Thoracic Society; guidelines; morbidity

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© 1999 by Thorax
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