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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
BACKGROUND
The 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.
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