The management of asthma: A case-scenario-based survey of family physicians and pulmonary specialists

This study assessed family physicians' and pulmonary specialists' approache s to the treatment of adult outpatient asthma using a self-administered que stionnaire consisting of six asthma scenarios of varying severity levels. O ne hundred sixty-three randomly selected family physicians and pulmonary sp ecialists completed the questionnaire (response rate of 80%). We observed t hat, regardless of asthma severity, more than 75% of physicians (regardless of specialty) would not include oral theophylline or nonsteroidal anti-inf lammatory preparations in their treatment approach. Pulmonary specialists' and family physicians' approaches to mild asthma were similar (more than 90 % recommended an inhaled beta(2)-agonist). However, considerable difference s existed among and between physician groups for the remaining scenarios. F or example, with an exacerbation associated with an upper respiratory tract infection, family physicians were more likely to recommend oral antibiotic s (p < 0.0001) and a same-day outpatient visit (p < 0.0001), whereas specia lists were more likely to increase the inhaled corticosteroid dosage (p < 0 .001). Overall, disagreement was observed almost twice as often among famil y physicians than among specialists. Our results suggest that physicians va ry markedly in their reported use of most interventions available to treat asthma, even when the disease severity is specified.