More recent data suggest guidelines are being adhered to

EDITOR,--J O Warner found that too few children were prescribed preventive treatment and too many were prescribed oral £ agonists in 1990-1.1 Though international paediatric guidelines had been distributed, the British Thoracic Society's guidelines were published later, in 1993. With more widespread dissemination of guidelines in general practice and incentives for asthma clinics, shared care, and audit, trends in prescribing in primary care have probably changed.

We have data from a questionnaire survey of prescribing in chronic diseases by 1000 general practitioners, who provided data over random four week periods between July 1990 and June 1995 (the new and change therapy inquiry). The data presented refer to all newly started courses of treatment for asthma for patients aged between 5 and 18 (that is, the incidence of new prescriptions). The figures did not include repeat prescribing (analogous to the prevalence). Our results show that the proportion of prescriptions for asthma that were for new courses of inhaled steroids increased by 49.6% between 1990 and 1995, from 25.8% to 38.6% (table). Prescribing of new courses of oral bronchodilators havled. Although the proportion of sodium cromoglycate inhalers decreased by one third, general practitioners are not alone in making this deviation from the guidelines, as only 21% of hospital general paediatricians surveyed used sodium cromoglycate as the first step.2

These incidence data probably reflect new prescribing habits more accurately than prevalence data, as general practitioners are less likely to change established treatments in patients with stable disease.

These results suggest that the guidelines are now being more closely adhered to. We agree with Warner, however, that prospective trials of prophylaxis are needed, with emphasis on long term adverse effects, compliance, and the requirement for inhaled short acting £ agonists.