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Management and control of asthma as assessed by actual/best function and corticosteroid use 1980-1993/4.

AbstractThis study aimed to determine whether the changes in practice in the management of asthma since the early 1980s have improved standards (as assessed by higher actual/best function) and reduced the need for oral corticosteroids. All asthmatic outpatients were reviewed in 1980, 1983, 1988/89 and 1993/94. Therapeutic step, defined by suppressive medication alone, actual and best peak expiratory flow (PEF) were recorded. Cohorts from 1980, 1983 and 1988/89 were identified in whom best function was established on all subsequent occasions. Changes in practice demonstrated by cross-sectional review of all subjects were interpreted with the aid of longitudinal analysis of the cohorts. Attendance increased from 463 in 1980 to 772 in 1993/94. Between 1983 and 1993/94, the proportion maintained on inhaled corticosteroids increased from 49 to 84% with increased use of higher doses. Mean actual/best PEF rose from 80 to 87%, improving at each therapeutic step. The proportion needing rescue oral corticosteroids fell from 47 to 35% and maintenance oral corticosteroids from 20 to 9%. In the cohorts, there was a similar reduction in use of rescue corticosteroids, but not of maintenance oral corticosteroids. The study confirmed an increase in the use and dose of inhaled corticosteroids, and a better outcome at all treatment steps. The fall in the proportion of subjects dependent on oral corticosteroids was due to attrition, rather than weaning in later years.
AuthorsC K Connolly, S M Alcock, R J Prescott (Affiliation: Dept of Medicine, University of Newcastle upon Tyne, UK.)
JournalThe European respiratory journal : official journal of the European Society for Clinical Respiratory Physiology (Eur Respir J) Vol. 12 Issue 4 Pg. 859-64 (Oct 1998) ISSN: 0903-1936 DENMARK
PMID9817159 (Publication Type: Clinical Trial, Comparative Study, Journal Article, Research Support, Non-U.S. Gov't)
Chemical References
  • Adrenal Cortex Hormones
Topics
  • Administration, Inhalation
  • Administration, Oral
  • Adolescent
  • Adrenal Cortex Hormones (administration & dosage)
  • Adult
  • Asthma (diagnosis, drug therapy)
  • Cohort Studies
  • Cross-Sectional Studies
  • Female
  • Humans
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Prognosis
  • Respiratory Function Tests
  • Severity of Illness Index