Frequency of non-asthma GP visits predicts asthma exacerbations: an observational study in general practice

M.E. Hyland, B. Whalley, D.M.G. Halpin, C.J. Greaves, C. Seamark, S. Blake, M. Pinnuck, D. Ward, A.L. Hawkins, D. Seamark

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9 Citations (Scopus)

Abstract

Background: Being able to identify patients at risk of exacerbations is useful as it enables resources to be targeted at these patients.

Aims: 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.
Original languageEnglish
Pages (from-to)405-411
Number of pages7
JournalPrimary Care Respiratory Journal
Volume21
DOIs
Publication statusPublished - 26 Jul 2012

Keywords

  • exacerbation
  • asthma
  • adherence
  • management
  • GP visits
  • consultations
  • frequency

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