Background: Our professional development plan aimed to improve the primary care management of acute asthma, which is known to be suboptimal.

Thirty Two(41%) practices submitted details on 954 asthma patients. Positive patient outcomes were associated with practices operating a clinic organised by a specially trained asthma nurse(n=11). This group had fewer patients with symptoms(p<0.01), fewer acute attacks(p<0.01), more aggressive use of short course systemic steroids(p<0.001) and fewer patients with days lost due to asthma(p<0.05), compared to practices with clinics run by nurses not in possession of a diploma(n=14).These associations are likely to be clinically important. To improve patient management there is a strong case for recommending that all general practices employ a nurse with special training in asthma.

To review the human and economic cost of asthma and its impact on the Health Service. Methods: Observational study of 9467 patients of all ages and clinical severity of asthma in 319 Scottish general practices. The 'human cost' was calculated from assessment of symptoms and lifestyle disruption. Direct health care costs were determined from study of health service utilisation. Results: Only 1/3 of patients were free of asthma symptoms when reviewed and 770(12%) reported lost time from work/school due to asthma in the past month. 1916(20%) patients experienced an acute exacerbation in the previous 12 months. 1,412(15%) patients were on medication step zero of the British Thoracic Society (BTS) guidelines, 1660(18%) step one, 4310(45.5%) step-two, 1386(15%) step-three, 594(6%) step-four, and 105(1%) step five. The major component of health service cost was maintenance medication (67% of total). Only 5% of patients received hospital treatment but accounted for 19% of total direct health care spend. Conclusions: The human and economic costs of asthma are substantial and highlight a need to achieve improved clinical outcome. The simplistic data collection markers in the New GP Contract are unlikely to promote favourable change in outcome.

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