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At the heart of general practice since 1960

GMC will back down over adjudication

Patients with mild to moderate asthma can control their disease by using inhaled ster-oids only during periods of worsening symptoms, a controversial UK study suggests.

The research directly contradicts the British Thoracic Society/SIGN asthma guidance, which puts patients with milder asthma on step two of its plan and recommends regular inhaled steroids.

Study leader Dr Colin Greaves, research and development manager for Mid-

Devon primary care research group, said the BTS/SIGN guidelines should be updated to allow patients to use inhaled steroids for periods of two or three weeks as needed.

The BTS insisted its guidelines were 'very carefully researched' and said the study's conclusions were 'misleading'.

Researchers studied 176 patients treated in general practice, comparing those

who took inhaled steroids

regularly with others who

employed symptom-directed treatment or low dosing.

The study in the Primary Care Respiratory Journal (April) found that in patients with mild to moderate asthma, there was no difference between the treatment strategies in quality of life or unplanned visits to a doctor (see graph).

In patients with moderate to severe asthma, failure to adhere to treatment significantly worsened quality of life and doubled unscheduled visits.

Dr Greaves said: 'The study makes a case for a treatment step in between one and two ­ an action plan based on zero corticosteroid use, but stepping up to regular use when certain symptom-based criteria pertain, such as night-waking or colds.'

Dr Dermot Ryan, a member of the BTS guidelines steering group and a GP

in Loughborough, Leicestershire, argued the study's conclusion was 'flawed and misleading' as the finding could only be applied in specific groups of patients.

'In clearly defined patients, such as those with seasonal asthma or specific triggers, it would be reasonable to use intermittent treatment in the context of a patient self-management plan with a full education package. But we know from ongoing research that 90 per cent of patients do not have optimal asthma control.'

A study in the New England Journal of Medicne last month also supported the intermittent use of steroids in mild asthma.

By Nerys Hairon

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