How general practitioners manage acute asthma attacks.
BACKGROUND
The management of asthma attacks by general practitioners in 1992/93 was compared with 1991/92 in relation to recommended guidelines.


METHODS
The findings from a postal survey of 299 UK general practitioners who managed 2332 patients with an asthma attack in 1992/93 were compared with those from 218 practitioners who managed 1805 attacks in 1991/92. Management by a subgroup of practitioners from a special interest group was analysed separately.


RESULTS
In 1992/93 2031 (87%) of attacks were managed entirely by general practitioners, 251 (11%) were referred for admission to hospital, and 50 (2%) were managed by an accident and emergency department. There was no change in the pattern of management relative to 1991/92. Compared with recommended guidelines there was underuse of systemic steroids and nebulised bronchodilators. Between 1991/92 and 1992/93 use of systemic steroids in acute attacks increased from 56% to 71%, nebulised bronchodilators from 31% to 32%, and an increase in prophylactic medication after an acute attack from 41% to 49%. Contrary to guidelines, antibiotic use increased from 32% to 40% of attacks. Practitioners from a special interest asthma group gave more of their patients systemic steroids and nebulised bronchodilators both in 1991/92 and 1992/93.


CONCLUSIONS
Some aspects of the management of asthma attacks by general practitioners has changed in line with guidelines, but there is still a large gap between actual and recommended management.
Neville
R G
RG
Tayside Centre for General Practice, University of Dundee, UK.
Hoskins
G
G
Smith
B
B
Clark
R A
RA
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D001249:Asthma / Q000188:drug therapy*; D001993:Bronchodilator Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D005194:Family Practice; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008511:Medicine; D008875:Middle Aged; D009330:Nebulizers and Vaporizers; D010818:Practice Patterns, Physicians'; D013038:Specialization; D013256:Steroids; D006113:United Kingdom
D000900:Anti-Bacterial Agents; D000893:Anti-Inflammatory Agents; D001993:Bronchodilator Agents; D013256:Steroids