Intended for healthcare professionals

Practice BMJ Masterclass for GPs


BMJ 2007; 334 doi: (Published 19 April 2007) Cite this as: BMJ 2007;334:847
  1. Hilary Pinnock, clinical research fellow1,
  2. Rupal Shah, GP principal2
  1. 1Division of Community Health Sciences, GP Section, University of Edinburgh
  2. 2Battersea, London
  1. Correspondence to: H Pinnock Hilary.Pinnock{at}

    Practical tips

    • Ask specific questions about asthma control, such as the Royal College of Physicians' three questions: people who are used to living with asthma tend not to volunteer their symptoms unless asked specifically

    • Step up treatment if symptoms are not controlled: step down if your patient's asthma is stable

    • People who learn how to control their asthma are less likely to have exacerbations. Every encounter with medical services is an opportunity to review, reinforce, and extend patients' knowledge and skills

    • Patients' action plans should include details of their asthma drugs, advice about when to take further action, what to do if symptoms get worse, when to return to usual doses, and when to seek urgent medical help

    • Rhinitis is a very common comorbidity. Ask patients with asthma about nasal symptoms, and ask patients with rhinitis about wheeze

    The prevalence of active asthma in the United Kingdom is 5.8% according to data from the quality and outcomes framework of the new general medical services contract (which allocates 45 points for caring for patients with asthma). There are still about 1500 deaths a year from asthma in the UK, many of which may be preventable, and asthma affects about eight million people in the UK at some stage in their lives.

    What should I already know about this condition?

    Asthma is a variable condition. You can make the diagnosis by noting a history of variable symptoms, confirmed by variability of peak flow (or spirometry):

    • ≥20% variability in peak expiratory flow rate (PEFR) (≥60 l/min) on three days in a week for at least two weeks

    • ≥20% improvement in PEFR (or 15% with a 200 ml improvement in forced expiratory volume in one second (FEV1)) after treatment—for example

      • 10 minutes after inhalation of high dose β2 agonist (through a spacer)

      • After a six week course of inhaled corticosteroids

      • After 14 …

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