Abstract
INTRODUCTION: The 2003 British Guideline on the Management of Asthma states that in adults ‘Objective tests should be used to try and confirm a diagnosis of asthma before long-term therapy is started”. The primary aim of this study is to look at whether this recommendation is being met in practice. The secondary aims were a) to look at the methods adopted in making a diagnosis of asthma in primary care b) to look at any differences in the results of patients diagnosed in Box compared to elsewhere. METHODS: 165 case records of asthma patients over the Age of 7, selected by random number generation, in a single asthma -interested general practice(Box, Wiltshire) were analysed. Patients with a diagnosis of asthma made prior to age 5 were excluded (43) RESULTS: A total of 121 notes were included for study purposes. Demography: 70 females, 51 males Current age Mean= 42 (min 8 max 84) Age At diagnosis: Median =24.5 years (interquartile range 12-42) Patients diagnosed in Primary Care 112 (70 in Box, 42 elsewhere) Patients diagnosed in secondary care 9 Method of diagnosis in primary care Box Elsewhere Combined n=70 n-42 n=112 No criteria evident 5 (7%) 5 (13%) 10 (9%) Symptoms of asthma only 23(32%) 21(52%) 44(40%) Symptom response to beta agonist/oral steroids (No objective tests) 9(14%) 6(15%) 15 (13%) Objective evidence of asthma(*) 33 (47%) 8 (20%) 43 (38%) (*)Objective evidence to asthma includes peak flow variation on diary card, reversibility of peak flow/ Fev-1 with ß-2 agonist or prednisolone. Steroids were only used in 8 patients (7%) to diagnose asthma. Peak flow variability was used in 13 patients (12%) whereas 36 patients (32%) had reversibility tests carried out. CONCLUSIONS: Only 38% of a sample of patients diagnosed with asthma over the age of 5 in primary care have objective evidence of this diagnosis. Most asthma in this group was diagnosed on characteristic symptoms.(40%patients). Reversibility tests appear to be more commonly used than peak flow variability in diagnosing asthma in this group of patients.