title: Cross-sectional observations on the natural history of asthma.
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.
  
  
  OBJECTIVE
  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.
  
  
  METHODS
  A cross-sectional study and clinical assessment of asthma patients.
  
  
  METHODS
  A total of 12,203 patients from 393 general practices throughout the UK.
  
  
  METHODS
  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.
authors.affiliation: Tayside Centre for General Practice, University of Dundee, Kirsty Semple Way, Dundee DD2 4AD. r.g.neville@dundee.ac.uk
authors.forename: R G
authors.initials: RG
authors.lastname: Neville
authors.forename: C
authors.initials: C
authors.lastname: McCowan
authors.forename: G
authors.initials: G
authors.lastname: Hoskins
authors.forename: G
authors.initials: G
authors.lastname: Thomas
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001249:Asthma / Q000150:complications / Q000453:epidemiology / Q000628:therapy; D015982:Bias; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D010349:Patient Compliance; D006113:United Kingdom / Q000453:epidemiology