Issues at the interface between primary and secondary care in the management of common respiratory disease bullet 3: Providing better asthma care: what is there left to do?

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Abstract
The care of patients with asthma impinges on all levels of the health service and is a major component of the workload of general practices, accident and emergency departments, and medical outpatient clinics. Asthma is a frequent cause of hospital admission and a major contributor to the workload of on-call co-operatives and the ambulance service. It is therefore appropriate that asthma has become a high profile disease and the subject of numerous initiatives at both primary and secondary care levels. Because of the variable nature of asthma and the wide spectrum of severity, it is a prime example of a disease where all health care professionals should work to a common strategy, providing consistent care. In an ideal world these professionals would sit down together and agree core strategies for implementing guidelines, new therapies and assessment tools, and referral and follow up procedures. We do not live in an ideal world. This review addresses some of the areas in which primary and secondary health care professionals could work together to improve the care of patients with asthma. ### THE NEED FOR A COMMON ASSESSMENT TOOL There is a need to establish a common assessment tool which is equally acceptable to primary and secondary care, and which could serve as the basis of shared care for audit purposes. The basic simplistic approach of asking “how are you” and being told “fine” is a good way to finish a clinic early but a bad way of assessing asthma control. An in depth interview on life style and attitudes with comprehensive pulmonary function tests is equally inappropriate as a pragmatic means of assessing control in a busy clinic. A recent Royal College of Physicians symposium (M Pearson, personal communication) addressed this issue, reviewing work on questionnaires, the Jones morbidity index, and the Tayside asthma stamp. A consensus view identified three core …