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Letters

Routine telephone review of asthma: Further investigation is required

BMJ 2003; 326 doi: https://doi.org/10.1136/bmj.326.7401.1267-b (Published 05 June 2003) Cite this as: BMJ 2003;326:1267
  1. Brian McKinstry, senior researcher,
  2. David Heaney, senior researcher,
  3. Jeremy Walker, research fellow,
  4. Sally Wyke, director, Scottish School of Primary Care
  1. Community Health Sciences, Edinburgh University, Edinburgh EH8 9DZ
  2. Highlands and Islands Health Research Institute, University of Aberdeen, Beechwood Business Park North, Inverness IV2 3ED
  3. Research Unit in Health, Behaviour and Change, University of Edinburgh, Medical School, Edinburgh EH8 9AG
  4. Lister Institute, Edinburgh EH8 9DR

    EDITOR—Pinnock et al conclude that telephone consultation for asthma review is an efficient option for patients in primary care.1 We have several concerns about this study.

    Firstly, a large number of patients (654/932) chose not to take part, and a further 307 were excluded for other reasons. It is not inconceivable that patients who dislike telephone consultations could have entirely opted out even before the study started.

    Secondly, the assumption that actual observation of patients' inhaler technique and peak flow measurement is equivalent to asking patients about their technique or measurements causes concerns. Patients commonly deny problems using inhalers but often fail to demonstrate effective usage.

    Thirdly, the conclusion that both interventions were equally effective is somewhat spurious since, using their own instrument. neither intervention produced a difference in outcome three months later. It might be better to say both were equally ineffectual.

    Lastly we found in our randomised control trial of telephone triage versus face to face consultations for appointments on the same day2 that one of the main differences between the two types of consultation was the undertaking of opportunistic health promotion. It would have been interesting to know if anything other than asthma management (for example routine blood pressure measurements) was going on in these 20 minute appointments. We believe that further investigation of these problems is required before recommending this method of managing asthma.

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