title: Frequency of non-asthma GP visits predicts asthma  exacerbations: an observational study in general practice.
abstract: BACKGROUND
  Being able to identify patients at risk of exacerbations is useful as it enables resources to be targeted at these patients.
  
  
  OBJECTIVE
  To test the theoretically-derived prediction that the frequency of non-asthma related visits to the general practitioner (GP) predicts exacerbations.
  
  
  METHODS
  Clinical and demographic data and both self-report and prescription-based adherence data were obtained from 166 patients diagnosed with asthma attending a GP clinic, all of whom were prescribed inhaled corticosteroids (ICS). Asthma exacerbations (treated by the GP or in hospital) and non-asthma visits and symptoms were assessed from notes for the subsequent 5 years.
  
  
  RESULTS
  Exacerbations correlated with non-asthma visits (0.35), severity as measured by BTS step (0.28), and with prescription-based adherence (0.28). Asthma severity correlated with non-asthma visits (0.35). Receiver operating curves showed that ≥2 non-asthma visits per year provided 79% sensitivity and 58% specificity for detecting ≥3 exacerbations over 5 years. Poor adherence predicted outcomes only for patients with high levels of non-asthma visits (≥3) and only for those reporting regular-but-less ICS use but not symptom-directed ICS use.
  
  
  CONCLUSIONS
  Non-asthma visits are a good predictor of asthma exacerbations, particular in non-adherent patients. These results are consistent with a mechanism where exacerbations result from a combination of random oscillating specific and non-specific inflammatory processes. It is important to consider the total patient rather than just the lung when managing patients with asthma.
authors: School of Psychology, University of Plymouth, Plymouth, Devon, UK. mhyland@plymouth.ac.uk
authors: Michael E
authors: ME
authors: Hyland
authors: Ben
authors: B
authors: Whalley
authors: David M G
authors: DM
authors: Halpin
authors: Colin J
authors: CJ
authors: Greaves
authors: Clare
authors: C
authors: Seamark
authors: Sue
authors: S
authors: Blake
authors: Margaret
authors: M
authors: Pinnuck
authors: David
authors: D
authors: Ward
authors: Adam
authors: A
authors: Hawkins
authors: Dave
authors: D
authors: Seamark
mesh_terms: D000328:Adult; D001249:Asthma / Q000503:physiopathology*; D005260:Female; D005544:Forecasting; D058006:General Practice; D006296:Health Services / Q000706:statistics & numerical data*; D006801:Humans; D007249:Inflammation / Q000503:physiopathology; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D012372:ROC Curve; D012720:Severity of Illness Index