Asthma in Scotland: epidemiology and clinical management

Abstract

Asthma in Scotland is briefly reviewed including epidemiology, management and the potential for research, education and audit. Asthma is characterised by variable wheeze and shortness of breath caused by variable narrowing of the bronchial airways secondary to inflammation. Confusion with chronic obstructive airways disease is increasingly common in the elderly and epidemiological studies tend to focus on the age range 5-44 years. Asthma prevalence is critically dependent on the definitions used and exceeds 20% based on questionnaire alone, less if objective measurements of airways obstruction is also used: perhaps 15% in children, 5% in adults in Scotland. Comparisons between studies and countries are therefore potentially hazardous. Routine information sources confirm the high levels of morbidity and use of health services by asthmatic patients. A true increase in the prevalence of asthma in children over the last two decades appears likely. This has been compounded by increased willingness to use the diagnostic label of asthma. Asthma, hayfever and eczema have increased significantly in Aberdeen school children over the last 25 years and asthma symptoms and airways obstruction have increased significantly in South Wales. Similar increases are reported in New Zealand children between 1975 and 1985, the prevalence being significantly higher than in Welsh children using standardised methodology. In Zimbabwe an intriguing strong association has been demonstrated between asthma, urban life style and higher socio economic groups. Most asthma deaths are caused by bronchial narrowing and subsequent asphyxia. Asthma mortality has apparently increased in most industrialised countries but problems of definition remain even when attention is confined to the age span 5-44 years. The epidemic of asthma deaths in mid-60s was undeniable and may have reflected good symptomatic control by bronchodilators, which made doctors and patients neglect the underlying risk of asthma death. A gradual increase in asthma mortality in western countries over the 1970s and 1980s is apparent, including almost 5% annual increase in England and Wales between 1974 and 1984 which then levelled off. This may again reflect excess dependence on bronchodilator treatment and under-usage of steroid treatment. A more dramatic increase in mortality in New Zealand in the early 1980s is likely to have a number of contributory factors. In contrast, the mortality rate in Scotland had been relatively static over the last two decades, although hospital discharge rates have doubled. Emergency asthma self admission schemes developed in Edinburgh are increasing popular and these, along with nebulised bronchodilators in ambulances, may be beneficial.(ABSTRACT TRUNCATED AT 400 WORDS)