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

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 o r above of the British asthma management guidelines is uncertain. We have l ooked 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 practic es (population 38 865) in 1995/6 using computerised general practice record s. The patients' usual treatment was obtained from prescription data and ca tegorised by the appropriate step on the British guidelines on asthma manag ement. Two measures of morbidity, the request for 10 or more short acting b eta agonist inhalers a year or the need for a course of oral corticosteroid s 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 percen tage 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 pas t year 13.6% had been prescribed 10 or more beta agonist inhalers and 12.5% had received at least one course of oral corticosteroids. Both measures oc curred 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 beta agonists or a course of oral prednisolone came from those t aking low dose or no regular inhaled corticosteroid. Conclusions-Evidence of morbidity from asthma was found in many patients ta king little or no prophylactic medication and this should be amenable to im proved education. A different approach may be needed for patients with cont inuing morbidity who are already taking higher doses of prophylactic medica tion.