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GPs need to persuade asthma patients to take inhaled steroids at the onset of worsening symptoms rather than relying solely on bronchodilators, a major new study concludes.

The Europe-wide INSPIRE study found patients were missing a 'window of opportunity' to prevent asthma attacks ­ largely because they responded to symptoms by taking the 'wrong medication'.

As a result, INSPIRE found 47 per cent of asthma patients on maintenance medication were uncontrolled, with an average of 14 'worsenings' a year. A further 21 per cent were not well controlled and had an average of seven exacerbations.

Study leader Professor Martyn Partridge, professor of respiratory medicine at Imperial College London, said: 'For 15 years the British guidelines have made it clear patients should be given the skills to manage their own asthma and this is clearly not happening. We are finding ongoing morbidity even in people on regular maintenance therapy ­ they recognise they are getting worse but take the wrong medication.'

The INSPIRE study, presented at this week's European Respiratory Society conference in Copenhagen, Denmark, found the mean period from early signs to peak symptoms of a worsening was six days. The researchers said this provided a clear window of opportunity for prevention ­ given adequate patient awareness.

But the study found the most common response to signs of worsening was to increase use of short-acting ?-agonists. Inhaled steroid use was increased only when the worsening reached its peak.

Dr Dermot Ryan, a GP in Loughborough, Leicestershire, and member of the British Thoracic Society, said: 'There's a big failure in the UK ­ and in most European countries but the UK in particular ­ to educate patients as to what they should be doing if their symptoms get worse.'

Dr Tony Crockett, a GP in Shrivenham in Wiltshire and hospital practitioner in asthma, said inhaled steroids could be increased up to four times and short-acting bronchodilators rapidly increased to maximum.

Researchers interviewed 1,921 adults with asthma in eight countries.

Study proposals

to improve

patient control

·Check inhaler technique

·Ask the RCP three questions

·Give patient a written asthma action plan

By Daniel Cressey

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