Cross-sectional observations on the natural history of asthma

Background: Asthma is a major health care problem that affects all ages. It is uncertain whether asthma is a single clinical entity or a grouping of s eparate clinical syndromes that share a common set of treatment guidelines. Aim: To observe the symptoms, treatment step, and health service utilisatio n of a population of patients throughout the United Kingdom (UK) listed on an asthma register. Design of study: A cross-sectional study and clinical assessment of asthma patients. Setting: A total of 12 203 patients from 393 general practices throughout t he UK. Method: A database was used to observe the symptoms, treatment step, and he alth service utilisation of the asthma patients. Results: Children aged up to four years had a distinctive profile of sympto ms, including night time cough. They also experienced increased health serv ice utilisation including a high hospital admission rate. Symptoms in adult s became more common with increasing age. The pattern of symptoms in patien ts aged 45 years and over suggest many patients on asthma registers may hav e chronic obstructive pulmonary disease. Patients aged 16 to 30 years showe d a different pattern of health service usage to those aged 5 to 15 years a nd 31 to 45 years, relying more on unscheduled use of health services rathe r than a review-based management plan. Patients aged 16 to 30 years used le ss anti-asthma medication than those aged 5 to 15 years and 31 to 45 years. Conclusions: Databases may be a useful tool with which to study the natural history of asthma, but there are problems with bias. Several clinical subg roups exist within the broad diagnosis label of asthma. Knowledge of how th ese subgroups of doctor-diagnosed asthma use health services may help clini cians to create individual care plans for groups of patients.