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Gold, incentives and meh

GPs told to target patients who are overusing bronchodilators

GPs have been called on to root out asthma patients who perpetually overuse broncho-dilators after the large scale of the problem was revealed in a major new study.

A review of 41,000 patients at 862 Scottish practices revealed two-fifths of asthma sufferers are making their

condition worse by using ?-

agonist reliever drugs more frequently than national guidelines recommend.

They were four times more likely to suffer from night-time symptoms as a result

and six times as likely to

have daytime symptoms as those who used the drugs

correctly.

The findings follow research last year in 96,000

UK patients that suggested those who used short-acting ?-agonist excessively had a significantly higher risk of death from asthma if they failed

to also use inhaled steroids. The British Thoracic Society asthma guidelines recommend patients using a short-acting ?-agonist more than once

daily should be prescribed an in- haled corticosteroid alongside.

Patients in the Scottish study underwent review to assess asthma symptoms, medication compliance and inhaler technique against BTS guidance which stresses the im-portance of training patients

in correct inhaler technique.

Patients were deemed over-users if on step three or below of the joint guidelines and used short-acting ?-agonists once or more daily or on step four or five and used it at least twice daily.

A total of 15,840 patients ­ 38 per cent ­ were classed as overusing the drugs and they were 86 per cent more likely to have 'poor' inhaler technique and 46 per cent less likely to comply with medication.

Study leader Dr Gaylor Hoskins, research fellow at the Tayside Centre for General Practice based at the University of Dundee, said: 'If you are looking at records for overuse of bronchodilators the majority of these patients will have symptoms and we need to review their medication.

'Some people use broncho-dilators out of habit but you'll never know until you question them.'

Better training of asthma nurses, symptom recording and explanation of self-management plans would all help, she added.

Dr Hilary Pinnock, adviser to the BTS asthma guidelines, said overuse of ?-agonists remained a 'concern' despite the guidelines.

Dr Pinnock, a GP in Whitstable, Kent, said GPs could use practice prescription data to pick up suspected over-users and call them for

review.

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