A PROFILE OF ASTHMA AND ITS MANAGEMENT IN A NEW-SOUTH-WALES PROVINCIAL CENTER

Objective: To describe aspects of the manifestations and management of asthma in a community setting. Design: Cross-sectional survey. Setting: A NSW provincial centre in October 1991. Participants: Ninety-eight adults, identified from a population survey, with wheeze, shortness of breath, or cough, in the past year, and either airway hyperresponsiveness (AHR) or a reported doctor's diagnosis of asthma. Main outcome measures: Histamine challenge test to measure AHR; asthma quality of life questionnaire (AQLQ) score (with the maximum score of 10 corresponding with lowest quality of life); need for medical attention or time off work; medical management and self-management of asthma; and the extent of beta(2)-agonist use. Results: Of the 98 participants, 74 had had asthma diagnosed by their doctor, 34 had perennial asthma, and 30 had required medical attention or had missed work because of asthma in the preceding year. The median AQLQ score was 1.0 (interquartile range, 0.6-1.8). Inhaled steroids were used by 17 participants who accounted for 23% of those with medically diagnosed asthma, 32% of those with perennial asthma, 17% of those with moderate or severe AHR, 40% of those who had required medical attention or missed work because of asthma in the preceding year, and 31% of those with AQLQ scores in the top quartile. Only 18 participants owned a peak flow meter; seven had a written self-management plan; 18 stated they would respond to worsening asthma by starting or increasing treatment with inhaled steroids, and six would start therapy with orally administered steroids. Twelve had never used beta(2)-agonists and only five had purchased more than 12 beta(2)-agonist inhalers in the preceding year. Conclusions: The spectrum of asthma in this community sample included many adults with mild disease and few with severe disease. Many were not managed in accordance with the recommendations of the Asthma Management Plan, but overuse of beta(2)-agonists was not an important public health problem in this community.