Asthma management in primary care: does increasing patient medication improve symptoms?

Aims: We set out to observe the General Practitioner (GP) management of a cohort of asthma patients over a 2-year period by comparing asthma health status, spirometry, British Thoracic Society treatment step, inhaled medication uptake and psychological status. Changes in these parameters were assessed over the 2-year period. Methods: One hundred fourteen subjects were recruited from four GP practices, two in the inner city and two in suburbia. Subjects were assessed at baseline and at 2 years using the Juniper asthma quality of life questionnaire, the locally devised Q score (a simple patient-focused morbidity index) and the hospital anxiety and depression (HAD) scale. Spirometry (forced expiratory volume in 1 S, forced vital capacity and peak expiratory flow) was recorded using a Micro Medical portable spirometer (Micro Medical Ltd, Chatham, UK); the best values from three acceptable attempts were recorded. Results: Data for 90 subjects reviewed at baseline and at 24 months were compared to the original cohort of 114 subjects. Patients who had the treatment increased showed no apparent benefit over 2 years. They had similar physiology and symptom scores at baseline but had higher HAD scores (particularly depression element P < 0.05) initially. The picture remained constant over the 2 years. Conclusion: Asthma guidelines define the aim of treatment to minimise or abolish symptoms. We suggest that if the symptoms are not measured, they remain unrecognised. This is something that could and should be incorporated routinely into clinical practice because this is morbidity that is largely treatable.