Asthma in Greenwich, UK: impact of the disease and current management practices

Abstract

A great deal of the care of patients with asthma takes place in general practices. The aim of the present study was to describe the impact of asthma in the community and to identify current asthma self-management practices.A two-part questionnaire survey was conducted in a random sample (23%; n= 24,398) of persons aged 16-50 yrs, registered with one of the 41 general practices in Greenwich, London, UK. The two parts were: a screening questionnaire identifying persons with current asthma (defined as waking with shortness of breath in the last 12 months, attack of asthma in the last 12 months, or currently taking treatment for asthma); and an asthma questionnaire (completed by those with asthma) assessing quality of life, frequency of asthma symptoms, possession and use of self-management tools, and action in the event of an exacerbation of asthma. The crude response rate was 51%, but this may be an underestimate due to errors in the sampling frame.The prevalences of wheeze and asthma in the past 12 months were 26% and 14%, respectively. Among asthma patients: 43% reported symptoms occurring three or more times per week, and 20% were woken by asthma symptoms on three or more nights per week; most had asthma with a mild impact on quality of life; 26% used inhaled steroids on most days in the preceding month; 16% had a peak flow meter at home; and 7% had oral steroids available. Of the 44% of subjects with asthma, who could identify an exacerbation of asthma in the preceding 6 months: 19% had used a peak flow meter during the episode; 19% had changed their treatment without first being told to do so by a doctor; and 50% had sought urgent medical help. Smokers used less appropriate asthma management and subjects whose asthma had a severe impact on quality of life used more treatment and peak flow monitoring.In conclusion, the prevalence of asthma among adults in Greenwich, UK, has increased since a similar survey in 1986. Many people have fairly mild asthma and a smaller number have severe disease. Much remains to be done to promote appropriate strategies for self-management of asthma exacerbations.

Changes in the use of anti-asthmatic medication in an international cohort

“…A higher use of ICS in females than in males was also found in a recent study in the UK and the Netherlands [7]. Like MARKS et al [25], the current authors found that a lower proportion of asthmatic smokers were using ICS compared with nonsmoking asthmatics. Lower usage of anti-asthmatics in smokers was also found in a previous investigation [26].…”

Do hormonal contraceptives influence asthma severity?

“…For sample size calculations it was assumed that the mean and standard deviation of the AQLQ score would be similar to that found in a study of asthmatic adults aged 20±44 yrs in Greenwich, also in South London, UK [18]. A sample size of 500 was chosen to detect a difference of 5 points on the original 80-point scale between current users and non-users with >90% power, assuming that 30% of subjects would be current users.…”

Attitudes and beliefs of patients with asthma

“…For most patients it is relatively mild although, for some, it leads to hospital admission or even death. [1][2][3] There is a broad consensus among health professionals that asthma symptoms can be at least partially prevented or controlled by regular use of inhaled steroids and by high-dose inhaled ß2-agonists during acute attacks in conjunction with short courses of oral steroids. [4][5][6] To prevent or relieve attacks quickly, increasing emphasis has been placed on self-management of asthma.…”