Abstract
Asthma is a chronic disease estimated to affect 6–7% of the total UK population. In addition, a number of studies have shown that asthma has become commoner since the 1970s, especially in children. The diagnosis of asthma can be difficult and its management requires the involvement of patients in a long-term treatment plan, something which general practitioners may be unable to achieve easily in the average 10-min consultation. As a consequence, asthma is underdiagnosed and undertreated. Deaths from the disease are often avoidable with timely and sufficient use of the available medication.(3,4) In order to support this, the British Thoracic Society (BTS) has published guidelines for asthma management based upon a stepwise approach, in which a patient is categorized as being on one of five steps according to the severity of his or her asthma. The guidelines give “rules of thumb” for deciding when the patient should move up or down the steps. The most recent version of the guidelines also included special rules for children.(5,6) Within a recent European Community project on Advanced Informatics in Medicien (AIM), we developed a prototype decision support system for asthma management targeted at the primary care setting and based on the British Thoracic Society guidelines. This paper reports this development, and describes the further work needed on the prototype. Plans for evaluation of the knowledge bases and for future full application production are also described.
Similar content being viewed by others
References
Gellert, A. R., Gellert, S. L., and Iliffe, S. R., Prevalence and management of asthma in a London inner city general practice.Brit. J. Gen. Pract. 40:197–201, 1990.
Peat, J. K., van den Berg, R. H., Green, W. F., et al., Changing prevalence of asthma in Australian children.Brit. Med. J. 308:1591–1596, 1994.
Carswell, E., Thirty deaths from asthma.Archs. Dis. Childh. 60:25–28, 1992.
Jones, K. P., Bain, D. J. G., Middleton, M., and Mullee, M. A., Correlates of asthma morbidity in primary care.Brit. Med. J. 304:361–364, 1992.
Guidelines on the management of asthma.Thorax 48:S1–S24, 1993.
Archives of disease in childhood asthma: A follow-up statement from an international paediatric consensus groups. 67:240–248, 1992.
Lanzola, G., and Stefanelli, M., Computational model 3.0. GAMES-II deliverable 25.30.12, 1993.
Leaning, M. S., Barosi, G., Kindler, H., Molino, G., Moustakis, V., Safran, E., and Samuel, P. (eds.), Prototype knowledge based systems in selected areas of clinical medicine. GAMES-II deliverable 36. 30.09, 1994.
van Heijst, G., Lanzola, G., Schreiber, G., and Stefanelli, M., Methodological foundations of medical KBS development. GAMES-II/T3.1/UnA/012/1.0, 1–35, 10.1993.
Leaning, M. S., Barosi, G., Kindler, H., Molino, G., Moustakis, V., Safran, E., and Samuel, P. (eds.), Application of the GAMES-II methodology to selected areas of clinical medicine. GAMES-II deliverable 37. 30.09, 1994.
Leaning, M. S., Austin, T., Samuel, P., Barosi, G., Kindler, H., Densow, D., Fliedner, T. M., Charissis, G., Morali, Vlachakis, Potamias, G., Molino, G., Safran, E., and Scherrer, J. R. (contribs), Results of medical evaluation of GAMES-II: Recommendations. GAMES-II Deliverable 38. 10, 1994.
An information management and technology strategy for the NHS in England: What are the Read codes? Information Management Group of the NHS Management Executive. London, HMSO, 1993.
Nunn, A. J., and Gregg, I., New regression equations for predicting peak expiratory flow in adults.Brit. Med. J. 298:1068–1070, 22,04, 1989.
Grimshaw, J. M., and Russell, I. T., Effect of clinical guidelines on medical practice, a systematic review of rigorous evaluation.The Lancet 342:1317–1322, 1993.
Author information
Authors and Affiliations
Additional information
Software Expertise Limited, 0181 521 6930.
Managed Health Systems Limited, 0171 925 1000. (Formerly at the Clinical Operational ResearchUnit, University College London).