The management of asthma in the early 1990s

Abstract

Recently published evidence from Glasgow (1) has again highlighted discrepancies in the care of patients with asthma depending upon whether they were admitted under a team containing a specialist in the field or under the care of a general medical team. In the most recent study of deaths from asthma (2) inadequate assessment, monitoring and treatment were again found to be contributory causes of death. But almost equally worrying was the finding of inadequate assessment, monitoring and treatment in a proport ion of the 'controls ' who survived. Conversations with colleagues suggest that as audit is being introduced throughout the country, many other districts are noting such discrepancies. Patients are still dying of their asthma and until 1986 this number has exceeded 2000 annually; and yet, patients rarely die when admitted to hospital under specialist care. Whilst there is less published data from General Practice, there is a similar suggestion that practices with Asthma Clinics, and trained respiratory nurses are offering a different standard to those without. In 1978, Anthony Seaton (3) in an Editorial in Thorax wrote 'The major problem in asthma today is the education of the profession about the disease'. Over a decade later in May 1989 one of us attended the 'International Conference on Quality Assurance and Health Care' in Amsterdam. Over lunch on the first day we were discussing the continuing high mortality from asthma and the fact that management of asthma in General Practice and by General Physicians continues to be far from ideal. This is despite the facts that effective remedies have never been more widely available and that Chest Physicians spend more time talking and writing about this condition at meetings for General Physicians and General Practitioners than they do on any other respiratory medical condition. It became clear that one approach which we had not tried was that of a conference convened to produce simple, but agreed, Guidelines, preferably in the form of a Statement that could be published in a General Medical Journal for each of the areas of asthma we considered important. Following a discussion ofthisidea at the Education Committee of the British Thoracic Society (BTS) in June 1989, we were asked to develop the suggestion into a formal proposal. By December 1989, with the agreement of the Council of the BTS, the following Organising Committee had been established: Dr Brian Harrison, Chairman (Chairman of the Standards of Care Committee of the BTS), Dr Martyn Partridge (Chairman of the Education Committee of the BTS and of the NAC Education Committee), Dr Anthony Hopkins (Director of the Research Unit of the Royal College of Physicians of London), Professor Stephen Holgate (Secretary of the Thoracic Medicine Committee of the RCP) and Dr David Costain (Director of the Acute Services Programme of the King's Fund Centre). We arranged a meeting at the Royal College of Physicians in London on 7 and 8 June 1990 and asked colleagues to prepare draft guidelines together with background papers to support those guidelines. These papers, with modifications based on constructive comments made at the meeting in June and at the subsequent BTS Summer meeting in July, form the basis of the present publication. The first two will be published in this issue of Respiratory Medicine and the following three in the November issue.