National asthma attack audit 1991-2. General Practitioners in Asthma Group.

Abstract

OBJECTIVE--To describe the frequency and characteristics of asthma attacks in the United Kingdom and to compare actual management with recommended guidelines for the management of attacks. DESIGN--Correspondence survey. SETTING--218 general practices in the United Kingdom. SUBJECTS--1775 patients of all ages who had a total of 1805 asthma attacks over three months. MAIN OUTCOME MEASURES--Patient characteristics, place of management of attacks, comparison of actual management with recommended guidelines. RESULTS--Of the 1805 attacks, 300 occurred in boys aged 0-9, 144 in girls aged 0-9, and 118 in women aged 20-29. The estimated frequency of attacks in the community was 14.3 per 1000 patients per year. 1546 (86%) patients with attacks were managed within general practice, 225 (12%) were admitted to hospital, and 34 (2%) were discharged from an accident and emergency department. Two patients died. On initial presentation, 248 (14%) patients were "not breathless," 900 (50%) were "moderately breathless," 535 (30%) were "breathless and distressed," 68 (4%) were "too breathless to talk," and 2 were "moribund." Recording of clinical data was variable. Underuse of nebulised bronchodilators and systemic steroid was apparent in all grades of clinical severity. Contrary to current guidelines for asthma management, "step up" in maintenance therapy after an attack was often not practised. CONCLUSION--Reported management was at variance with recommended guidelines. This has major implications for the design and distribution of future guidelines.