Routine telephone review of asthma

Editor—Pinnock et al conclude that telephone consultation for asthma review is an efficient option for patients in primary care.¹ We have several concerns about this study.

Firstly, a large number of patients (654/932) chose not to take part, and a further 307 were excluded for other reasons. It is not inconceivable that patients who dislike telephone consultations could have entirely opted out even before the study started.

Secondly, the assumption that actual observation of patients' inhaler technique and peak flow measurement is equivalent to asking patients about their technique or measurements causes concerns. Patients commonly deny problems using inhalers but often fail to demonstrate effective usage.

Thirdly, the conclusion that both interventions were equally effective is somewhat spurious since, using their own instrument. neither intervention produced a difference in outcome three months later. It might be better to say both were equally ineffectual.

Lastly we found in our randomised control trial of telephone triage versus face to face consultations for appointments on the same day² that one of the main differences between the two types of consultation was the undertaking of opportunistic health promotion. It would have been interesting to know if anything other than asthma management (for example routine blood pressure measurements) was going on in these 20 minute appointments. We believe that further investigation of these problems is required before recommending this method of managing asthma.