Guidelines versus practice: UK asthma nurses often recommend intermittent, symptom-driven use of inhaled corticosteroids.

BACKGROUND: Recent clinical trials suggest that intermittent use of inhaled corticosteroids (ICS) is safe for mild persistent asthma. Intermittent ICS use is inconsistent with current guidelines but is a common form of non-compliance. The aim of this study was to investigate how asthma nurses advise patients to use ICS. METHODS: Practice managers of 241 GP surgeries in the southwest of England were sent questionnaires to distribute to practice nurses. RESULTS: Questionnaires were returned by 105 nurses (104 had asthma-specific training). There was a wide variation in attitudes to guideline-based care and advice given to patients. 97% indicated that they sometimes advised patients to decrease their ICS use, 85% sometimes advised patients to stop their ICS when their asthma was well controlled, and 70% reported sometimes advising intermittent use. CONCLUSION: Asthma nurse recommendations are often inconsistent with guidelines. There is considerable variation between different asthma nurses in the advice given to patients.