Feedback to general practitioners of information about patients' asthma does not on its own lead to change in the outcome of clinical care.

Since management plans based on peak flow measurements are increasingly used, the relationship between peak flow rate and ensuing symptom frequency is of particular interest to the treatment of asthma. The objective of this study was to examine to what extent morning peak flow was related to symptom frequency during the day.In 168 out of 307 randomly selected adult asthmatics from a general practice population, adequate recordings of morning peak flow (amPF) and symptom frequency during the day (DSF) were obtained for 28 days. In each individual, the relationship between these two variables was studied and the mean values of these two variables over 28 days were calculated. The relationship between the means of the variables was also examined for the group as a whole.In individuals, the correlation between amPF and DSF varied widely; only 16% of patients had a good relationship (Pearson r -1 to -0.5). For the whole group, the relationship between mean amPF and mean DSF best fitted a curvilinear model (r -0.6). This was unaffected by age, sex or the use of inhaled steroids.For the majority of asthmatics, morning peak flow may be an unreliable predictor of expected symptoms during that day. Reliance on peak flow measurement as a tool enabling asthmatics to manage their asthma on a daily basis needs to be reconsidered.

SUMMARYThis review summarises current research into patients' attitudes and beliefs about asthma. We found few papers which explore the relationship between findings from qualitative research and measures of diseases process or outcome.Asthma is widely experienced as a stigmatising, emotionally disturbing and socially restricting disease. There is no single view of asthma that clinicians can learn and apply. Patients' responses to the disease are individual and complex, and the key to understanding patients' attitudes to and beliefs about asthma lies in the recognition of the enormous variation in their responses.It is clear from current research that the complex interplay of physiological, psychological and social influences which affect patients' attitudes and beliefs are discreet and accessible in individuals and should be brought to bear on the process of the consultation between the patient and the health professional.T he aim of this review was to draw together and summarise current evidence from research into patients' attitudes and beliefs about, and experience of, asthma. Much of the research identified is qualitative, and few papers have been found which explore the relationship between findings from qualitative research and measures of the disease process or outcome. The review was carried out by searching the electronic databases Medline, Bids-Embase, Bids-SSSI and BIDS IBSS, and by manual search of three leading respiratory journals and two leading medical sociology journals. The research databases of the National Health Service and the National Asthma Campaign were also examined. A variety of search histories were used including the key words 'adherence', 'attitudes', 'beliefs', 'compliance', 'experience', 'impact', 'morbidity' and 'symptoms'. EXPERIENCE OF ASTHMAAsthma is a disease characterised by unpredictable symptoms. For most patients it is relatively mild although, for some, it leads to hospital admission or even death. [1][2][3] There is a broad consensus among health professionals that asthma symptoms can be at least partially prevented or controlled by regular use of inhaled steroids and by high-dose inhaled ß2-agonists during acute attacks in conjunction with short courses of oral steroids. [4][5][6] To prevent or relieve attacks quickly, increasing emphasis has been placed on self-management of asthma. 7,8 In the selfmanagement of asthma, patients are encouraged to react to changing symptoms by changing the dosage and combination of their own drugs. There are few diseases in which the patient is expected to undertake such an active role in determining their own drug regimens. For many asthmatics, these treatment strategies have not succeeded, and rates of morbidity and mortality remain stubbornly high.As the experience of asthma varies widely, it is not surprising that attitudes and beliefs are also widely differing. Juniper and colleagues 9 found that, from among symptoms, emotions, environmental factors, physical activities and practical problems, shortness of breath and chest tightne...

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