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VIEWS & REVIEWS

Achieving better control in.mna 'Surveys have shown that many patients with asthma

remain poorly controlled even in well organised general practices that take an active interest in asthma care. ' This is the conclusion of an Oxford general practitioner, Duncan Keeley, writing in the BMI.

He points to several beliefs, attitudes and practices of doctors which he considers may contribute to this situation: • failure to identify asthmatic symptoms • the erroneous assumption that regular use of

bronchodilators in small doses provides adequate control, and the belief that using high doses of a bronchodilator during an asthma attack may be hazardous to the patient

• reluctance to use effective doses of inhaled steroids in the mistaken belief that they may be harmful

• neglecting to ensure that patients' inhaler technique is adequate

• insufficient use of large volume spacers - '1M best availtIble method/or taking inhaled ngs'

• undermining patients' confidence by failing to give consistent advice. Dr Keeley believes that morbidity in asthma is

still 'unacceptably high', despite the availability of effective therapies, because of the failure to implement well-established guidelines. Keeley D. How 10 achieve better outcome in trealmenl of asthma in general practi<:e. British Medical JoumaI307: 1261-1263. 13 Nov 1993 8IJI2l4Om

20 Nov 1993 INPHARMAe ISSN 0156-270319311120-0021$1.00° Adla IntlllIIIItIon8l Ltd