Primary care based clinics for asthma

Asthma is a common illness causing wheezing, coughing and difficulty with breathing in adults and children. Asthma is becoming increasingly common worldwide and this is especially true in higher income countries. There has been a move towards delivery of asthma care via primary care based asthma clinics in such countries. Such clinics comprise organised routine asthma care within a dedicated, regular time slot; these are usually nurse led and supported by doctors. However it is not yet known whether these clinics are effective.

This review aimed to explore this question and included three studies with a total of 466 participants. These studies did not find any overall difference between asthma clinic and usual clinical practice care by a general practitioner for the following outcomes: A&E department visits for asthma, use of reliever or preventer medication for asthma and quality of life measures, but there was considerable uncertainty about these results. One study found that there was a reduction in nocturnal awakening due to asthma in the asthma clinic group compared to control but no difference in other symptom outcomes reported. Given the limited evidence found in this review, we believe that there is a need for further evidence in order to assess the effectiveness of asthma clinics.

Authors' conclusions: 

There is limited evidence of efficacy for primary care based asthma clinics, and firm conclusions cannot be formed until more good quality trials have been carried out.

Read the full abstract...
Background: 

Asthma is defined as the presence of variable airflow obstruction with symptoms (more than one of wheeze, breathlessness, chest tightness, cough). It is becoming increasingly common worldwide and this is especially true in higher income countries. In several of these countries there has been a move towards delivery of asthma care via primary care based asthma clinics. Such clinics deliver proactive asthma care sited within primary care, via regular, dedicated sessions which are usually nurse led and doctor supported. They include organised recall of patients on an asthma register and care usually comprises education, symptom review and guideline-based management. Despite the proliferation of such clinics, especially in countries such as the United Kingdom (UK), there is a paucity of evidence to support their use. This review sets out to look at the evidence for the effectiveness of asthma clinics.

Objectives: 

To determine the effectiveness of organised asthma care delivered via primary care based asthma clinics.

Search strategy: 

We searched the Cochrane Airways Group Specialised Register of trials (last search December 2011) and reviewed reference lists of all primary studies for additional references.

Selection criteria: 

We included randomised controlled trials of primary care based asthma clinics with a parallel group design, where clinics took place within dedicated time slots and included face-to-face interaction with doctor or nurse and control groups received usual clinical practice care by a general practitioner.

Data collection and analysis: 

Two review authors independently assessed the trials for inclusion and conducted all data extraction and analysis. All disagreements were resolved by discussion.

Main results: 

A total of three studies involving 466 participants were included. There was no statistically significant difference between the asthma clinic group and the control group for most outcomes (primary outcomes: asthma exacerbations leading to hospitalisation or accident and emergency (A&E) visit, use of reliever and preventer medication, quality of life; secondary outcomes: symptoms, time lost from work and withdrawals from the intervention or usual care). However, the confidence intervals were wide for all outcomes and there was substantial heterogeneity between the studies for both A&E visits and time lost from work. One study (101 patients) looked at nocturnal awakenings due to asthma and found a statistically significant reduction in the number of patients reporting this symptom in the asthma clinic group compared to the usual care group (OR 0.31; 95% CI 0.12 to 0.77). There were no studies looking at the secondary outcome of exacerbations requiring oral steroids.

Share/Save