title: Effect of spirometry and medical review on asthma control in patients in general practice: a randomized controlled trial.
abstract: OBJECTIVE
  Although guidelines for asthma emphasize the importance of spirometry for continuity and evaluation of care, it is underused in general practice. The objective of this study was to investigate the effect of spirometry and medical review on asthma control in general practice over 12 months.
  
  
  METHODS
  Patients were recruited through 31 practices, which were randomly allocated to one of three groups: Group A had 3-monthly spirometry with medical review, Group B spirometry only before and after the trial, and Group C usual care. Asthma control data were analysed by intention to treat using non-parametric tests and logistic regression models fitted to allow for confounders, repeated measures and clustering by practice.
  
  
  RESULTS
  The trial was completed by 195 patients (Group A 69, Group B 78, Group C 48). Asthma control improved in all groups during the 12 months trial, most impressively in Group A (odds ratio per 3 months = 1.27, 95% confidence interval: 1.08-1.49, P = 0.004), but the difference between the groups' respective 3-monthly changes was not significant. At 6 months, asthma control in Group A had increased more from baseline than in Groups B + C (P = 0.006).
  
  
  CONCLUSIONS
  Regular spirometry with medical review was associated with improved asthma control in general practice patients, while there was less improvement in either the spirometry only or usual care group. The mechanisms of this improvement may include appropriate adjustment of medication and improved compliance.
authors.affiliation: Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, The Alfred, Melbourne, Victoria, Australia
authors.forename: Siao Ming
authors.initials: SM
authors.lastname: Oei
authors.forename: Francis C K
authors.initials: FC
authors.lastname: Thien
authors.forename: Rosa L
authors.initials: RL
authors.lastname: Schattner
authors.forename: Nabil D
authors.initials: ND
authors.lastname: Sulaiman
authors.forename: Kate
authors.initials: K
authors.lastname: Birch
authors.forename: Pam
authors.initials: P
authors.lastname: Simpson
authors.forename: Eleonora A
authors.initials: EA
authors.lastname: Del Colle
authors.forename: Rosalie A
authors.initials: RA
authors.lastname: Aroni
authors.forename: Rory
authors.initials: R
authors.lastname: Wolfe
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Abramson
mesh_terms: D000280:Administration, Inhalation; D000328:Adult; D000368:Aged; D018927:Anti-Asthmatic Agents / Q000627:therapeutic use; D001249:Asthma / Q000188:drug therapy* / Q000503:physiopathology*; D005260:Female; D058006:General Practice; D006801:Humans; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D010349:Patient Compliance; D017410:Practice Guidelines as Topic; D013147:Spirometry / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
chemical_list: D018927:Anti-Asthmatic Agents