Trends in primary care consultations for asthma in Switzerland, 1989-2002

Background There is widespread debate about trends in the occurrence of asthma in industrialized countries. This study was conducted to investigate time trends in consultations for asthma in primary care in Switzerland. Methods Prospective observational study from 1989 to 2002 within the Swiss Sentinel Surveillance Network; a primary care surveillance system. We used time series analysis and non-parametric smoothing methods to investigate long-term and short-term trends in rates of asthma episodes per 1000 consultations. From 1994 to 2002 we compared rates of first episodes with all subsequent consultations for asthma. Results Overall consultation rates for asthma per 1000 primary care consultations increased from 1989 to 1994 then stabilized and have declined since 2000. Longterm trends showed a small decline in first consultations for asthma from an average of 0.78 ( 95% credibility intervals (CI) 0.74 - 0.81) in 1999 to 0.62 (95% CI 0.55 - 0.69) per 1000 consultations in 2002. Subsequent consultations for asthma have been declining since at least 1994, from an average of 1.5 (95% CI 1.40 - 1.61) per 1000 consultations in 1994 to 0.93 (95% CI 0.82 - 1.04) in 2002. In addition, the ratio of subsequent to first episodes of asthma fell in all age groups. Conclusions In Switzerland, primary care consultations for asthma, subsequent to the initial diagnosis, have been declining since 1994. This is more likely to be owing to an increase in the use of home medication than to a shift in care to hospital settings. The incidence of diagnosed asthma might also be decreasing.