Abstract
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 separate clinical syndromes that share a common set of treatment guidelines. AIM: To observe the symptoms, treatment step, and health service utilisation 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 the UK. METHOD: A database was used to observe the symptoms, treatment step, and health service utilisation of the asthma patients. RESULTS: Children aged up to four years had a distinctive profile of symptoms, including night time cough. They also experienced increased health service utilisation including a high hospital admission rate. Symptoms in adults became more common with increasing age. The pattern of symptoms in patients aged 45 years and over suggest many patients on asthma registers may have chronic obstructive pulmonary disease. Patients aged 16 to 30 years showed a different pattern of health service usage to those aged 5 to 15 years and 31 to 45 years, relying more on unscheduled use of health services rather than a review-based management plan. Patients aged 16 to 30 years used less 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 subgroups exist within the broad diagnosis label of asthma. Knowledge of how these subgroups of doctor-diagnosed asthma use health services may help clinicians to create individual care plans for groups of patients.
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Selected References
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- Ayres J. G., Noah N. D., Fleming D. M. Incidence of episodes of acute asthma and acute bronchitis in general practice 1976-87. Br J Gen Pract. 1993 Sep;43(374):361–364. [PMC free article] [PubMed] [Google Scholar]
- Kaur B., Anderson H. R., Austin J., Burr M., Harkins L. S., Strachan D. P., Warner J. O. Prevalence of asthma symptoms, diagnosis, and treatment in 12-14 year old children across Great Britain (international study of asthma and allergies in childhood, ISAAC UK) BMJ. 1998 Jan 10;316(7125):118–124. doi: 10.1136/bmj.316.7125.118. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Magnus P., Jaakkola J. J. Secular trend in the occurrence of asthma among children and young adults: critical appraisal of repeated cross sectional surveys. BMJ. 1997 Jun 21;314(7097):1795–1799. doi: 10.1136/bmj.314.7097.1795. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Markowe H. L., Bulpitt C. J., Shipley M. J., Rose G., Crombie D. L., Fleming D. M. Prognosis in adult asthma: a national study. Br Med J (Clin Res Ed) 1987 Oct 17;295(6604):949–952. doi: 10.1136/bmj.295.6604.949. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Martin A. J., McLennan L. A., Landau L. I., Phelan P. D. The natural history of childhood asthma to adult life. Br Med J. 1980 Jun 14;280(6229):1397–1400. doi: 10.1136/bmj.280.6229.1397. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Neville R. G., Hoskins G., Smith B., Clark R. A. Observations on the structure, process and clinical outcomes of asthma care in general practice. Br J Gen Pract. 1996 Oct;46(411):583–587. [PMC free article] [PubMed] [Google Scholar]
- Ninan T. K., Russell G. Respiratory symptoms and atopy in Aberdeen schoolchildren: evidence from two surveys 25 years apart. BMJ. 1992 Apr 4;304(6831):873–875. doi: 10.1136/bmj.304.6831.873. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Phelan P. D. Asthma in children: epidemiology. BMJ. 1994 Jun 18;308(6944):1584–1585. doi: 10.1136/bmj.308.6944.1584. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Silverman M. Out of the mouths of babes and sucklings: lessons from early childhood asthma. Thorax. 1993 Dec;48(12):1200–1204. doi: 10.1136/thx.48.12.1200. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Strachan D. P., Butland B. K., Anderson H. R. Incidence and prognosis of asthma and wheezing illness from early childhood to age 33 in a national British cohort. BMJ. 1996 May 11;312(7040):1195–1199. doi: 10.1136/bmj.312.7040.1195. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Wardman A. G., Binns V., Clayden A. D., Cooke N. J. The diagnosis and treatment of adults with obstructive airways disease in general practice. Br J Dis Chest. 1986 Jan;80(1):19–26. doi: 10.1016/0007-0971(86)90005-7. [DOI] [PubMed] [Google Scholar]