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

Abstract

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. Methods-A 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. Results-Of 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. Conclusions-Evidence of morbidity from asthma was found in many patients taking little or no prophylactic medication and this should be amenable to improved education. A diVerent approach may be needed for patients with continuing morbidity who are already taking higher doses of prophylactic medication.

Poor adherence with inhaled corticosteroids for asthma: can using a single inhaler containing budesonide and formoterol help?

“…It has been identified in 30% to 60% of patients, [4][5][6] and is associated with poor asthma control, 2 and increased mortality. 22 Although some studies have shown that patient education can improve adherence with inhaled corticosteroids, these interventions have been labour intensive, and their implementation has had limited success overall.…”

“…[4][5][6] Reasons for poor adherence are numerous, but include a dislike of inhaled corticosteroids, lack of rapid symptom relief, and complicated treatment regimens. [7][8][9] Because the β 2 -agonist formoterol has a rapid onset and long duration of action, 10 it can be used for symptom relief and maintenance treatment.…”

Estudo comparativo entre o manejo da asma em uma unidade de referência da rede pública de Porto Alegre (RS) e as proposições do III Consenso Brasileiro no Manejo da Asma

“…(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13) In the attempt to improve asthma control, consensus guidelines including all of the relevant scientific information published have been systematically drawn up in various countries in order to aid health professionals in carrying out the treatment of these patients. However, the use of these guidelines by health professionals, in rich as well as in poor countries, have proven quite insufficient.…”

Asthma control: where do we fail?

“…Reiterating this information both towards physicians and patients would therefore, seem very appropriate. Studies based on questionnaires as well as on general practice records indicate that physicians insufficiently prescribe maintenance treatment [18,19]. However, specific education programs increase both the prescription rate of and adherence to steroids, improving the overall degree of asthma control [9±11, 20].…”