Objective-To compare the efficacy of self management ofasthma with traditional treatment.Design-12 month prospective randomised trial. Setting-Outpatient clinics in Finland. Subjects-115 patients with mild to moderately severe asthma.Interventions-Patient education and adjustment of anti-inflammatory therapy guided by peak flow measurements.Main outcome measures-Unscheduled admissions to hospital and outpatient visits, days off work, courses of antibiotics and prednisolone, lung function, and quality oflife.Results-The mean number of unscheduled visits to ambulatory care facilities (0 5 higher in the self management group than in the traditionally treated group. In both groups admissions for asthma were rare. Conclusions-Self management reduces incidents caused by asthma and improves quality oflife. IntroductionDeaths from asthma have been associated with underestimation of its severity, delays in starting treatment in exacerbations, and unsatisfactory routine management and treatment of asthma.' 2 Potentially preventable factors are common in deaths from asthma, and 73% of admissions to hospital for acute asthma could be avoided with proper prior medical care.'3 At least 40% of people with asthma do not react appropriately when symptoms of asthma worsen and over half of the patients admitted with acute asthma have had alarming symptoms for a week before admission.45 In its study of deaths due to asthma in the early 1 980s the British Thoracic Association recommended that patients should measure their own peak flow rates and treat deteriorating symptoms

The oral health status and stimulated salivary flow rate of 33 adult asthmatic outpatients were compared with those of 33 nonasthmatic controls. The groups were matched by age and sex, and an adjustment for education was made in the statistical analysis. In the oral examination, a small difference in the prevalence of caries was observed when the sums of decayed, missing, and filled teeth (DMFT) were compared. The mean (SD) crude DMFT score was 20.1 (5.8) in the asthma group and 18.4 (7.6) in the control group. A statistically significant difference was seen in the amount of periodontal inflammation and in the stimulated salivary flow rate between the groups. The mean (SD) crude periodontal status index (PSI) was 52.7% (23.8%) in the asthmatics and 37.1% (20.4%) in the controls. The 95% confidence interval (95% CI) for the difference in adjusted means of PSI ranged from 0.1% to 21.9% (P = 0.05). In the stimulated salivary flow rate, crude mean values were 1.0 (0.5) ml/min and 1.3 (0.5) ml/min, respectively, and the 95% CI for the difference was from 0.05 ml/min to 0.57 ml/min (P = 0.01). Mucosal lesions in the oral cavity were found in 15 asthmatics (45%) and in eight controls (24%). In conclusion, the results of this study support the hypothesis that adult asthmatics have a higher risk of oral diseases than nonasthmatic subjects.

No abstract

No abstract

Objective: To evaluate the READER model for critical reading by comparing it with a free appraisal, and to explore what factors influence different components of the model. Design: A randomised controlled trial in which two groups of general practitioners assessed three papers from the general practice section of the BMJ. Setting: Northern Ireland. Subjects: 243 general practitioners. Main outcome measures: Scores given using the READER model (Relevance, Education, Applicability, Discrimination, overall Evaluation) and scores given using a free appraisal for scientific quality and an overall total. Results: The hierarchical order for the three papers was different for the two groups, according to the total scores. Participants using the READER method (intervention group) gave a significantly lower total score (P<0.01) and a lower score for the scientific quality (P<0.0001) for all three papers. Overall more than one in five (22%), and more men than women, read more than 5 articles a month (P<0.05). Those who were trainers tended to read more articles (P<0.05), and no trainers admitted to reading none. Overall, 58% (135/234) (68% (76/112) of the intervention group) believed that taking part in the exercise would encourage them to be more critical of published articles in the future (P<0.01). Conclusion: Participants using the READER model gave a consistently lower overall score and applied a more appropriate appraisal to the methodology of the studies. The method was both accurate and repeatable. No intrinsic factors influenced the scores, so the model is appropriate for use by all general practitioners regardless of their seniority, location, teaching or training experience, and the number of articles they read regularly.