Managing asthma in primary care : a two year observational study of real life medical practice

Rimington, LD

Abstract

Guidelines for the management of asthma in the UK have been published (BMJ, 1990, Thorax, 1993 and 1997) and embraced by many GP practices with improved outcome for patients. The study aims to observe and follow a cohort of adult asthma subjects from differing primary health care settings over a two-year period. Also to assess a newly devised patient focused morbidity index (Q score) by comparison to an established asthma specific quality of life questionnaire (AQLQ, Juniper et al, 1993).

One hundred and fourteen subjects from four GP Practices, two inner city and two suburban were studied. Morbidity was assessed by AQLQ and Q score (Rimington et al, 2001), psychological status by the hospital anxiety and depression (HAD) scale (Zigmond and Snaith, 1983). Spirometry values (forced expiratory volume in one second, FEV1), peak expiratory flow (PEF) and details of current treatment as per BTS guidelines treatment step were recorded as markers of asthma severity. Subjects were assessed at baseline, twelve and twenty-four months. A random sub set of patients was asked to repeat certain elements of the study protocol at two weeks in order to assess the reliability of the Q score.

The Q score correlated from baseline to two weeks (rs=0.61) as did AQLQ symptom score (rs=0.74) both p<0.01. At baseline AQLQ symptoms correlated with PEF (rs=0.40, p<0.001) and with BTS guidelines treatment step (rs=0.25, p=0.001) as did the Q score. Similar levels of correlation were reported for FEV1 with symptoms. HAD scores also correlated to AQLQ and Q score, but there was little correlation with lung function. At one and two year follow up no significant differences were observed in subjective or objective markers of asthma. There was a significant increase (p<0.001) in the number of subjects in the higher BTS guidelines treatment steps from baseline to twelve and twenty-four months while psychological symptoms remained high for inner city patients.
In conclusion the Q score yields similar results to the AQLQ and is quick and easy to use in any busy clinic. The GP practice, at the forefront of asthma care should be offering appropriate therapy and regular review. The Q score used as a patient focused morbidity index can be a useful audit tool. Altering medication can give the impression of treating asthma but with out short-term reassessment the same levels of morbidity can persist.

Citation

Rimington, L. Managing asthma in primary care : a two year observational study of real life medical practice. (Thesis). University of Salford, UK

• Thesis Type: Thesis
• Deposit Date: Jun 11, 2009
• Publicly Available Date: Jun 11, 2009
• Additional Information: Additional Information : PhD supevisor: Dr. D.H. Davies
• Award Date: Jan 1, 2001