Establishing the safety and effectiveness of a diagnostic therapeutic trial for asthma in community elderly

哮喘是澳大利亚的一个主要健康优先事项，影响着200多万人。它被低估了，是老年人严重发病率的一个来源。澳大利亚联邦的研究人员以前的工作表明，在55岁以上的人群中，大约40%的哮喘没有得到诊断。在这个年龄段，严重程度与确诊的患者相当，比55岁以下确诊的患者更严重。大多数(80%)哮喘死亡发生在55岁以上的人群中。有明确的患者和系统因素导致漏诊。患者因素目前正在全科医生患者试点研究中得到解决。系统问题使得在全科医学中诊断哮喘成为一项困难的任务。这项研究很重要，因为老年人更有可能去看全科医生，而不是呼吸问题的专家。肺活量测定在一般情况下并不常见，而且质量不同。全科医生最常见的诊断方法是对药物进行诊断性试验，以提供哮喘的证据。这可以分为四个要素：治疗试验的进入标准；治疗试验中的药物选择；治疗试验的时间长度；以及治疗试验中的评估标准。没有循证指南可以帮助全科医生在这些阶段中的每个阶段，使治疗试验成为一个非常重要的安全性和有效性问题，特别是在老年人中。建议的研究目的是在具有代表性的老年人人群样本中进行随机对照试验，以确定诊断治疗试验的循证成分，以指导全科医生。这项研究还将评估哪些诊断问题和医学测试对全科医生诊断老年人哮喘的帮助最大。

Asthma is a major Australian health priority affecting over 2 million people. It is under-diagnosed and a source of significant morbidity in older people. Previous work by the investigators for the Commonwealth of Australia has shown that in the over 55-year age group approximately 40% of asthma is undiagnosed. In this age group severity is comparable with those diagnosed and worse than those diagnosed under the age of 55 years. Most (80%) of asthma deaths occur in the people aged greater than 55 years. There are clear patient and system factors that contribute to under diagnosis. The patient factors are currently being addressed in a general practice patient pilot study. System issues make the diagnosis of asthma in general practice a difficult task. The study is important, as older people are more likely to access the general practitioner than a specialist for respiratory problems. Spirometry in general practice is not common and is of variable quality. The most common approach to diagnosis by the general practitioner is a diagnostic trial of medication to provide evidence of asthma. This can be broken down into four elements of: entry criteria to a therapeutic trial; choice of drug in a therapeutic trial; length of time for a therapeutic trial, and; assessment criteria in a therapeutic trial. No evidence-based guidelines are available to assist the general practitioner in each of these stages making the therapeutic trial a safety and effectiveness issue of major importance, especially in the older person. The purpose of the study proposed is to conduct a randomised controlled trial in a representative population sample of older people to determine the evidence-based components of a diagnostic therapeutic trial for the guidance of general practitioners. The study will also assess which diagnostic questions and medical tests provide greatest assistance to the general practitioner in diagnosing asthma in the older person.