'More of my patients are victims, but their symptoms are under much better control'

Looking after patients with asthma is bread-and-butter work for general practitioners.

Looking after patients with asthma is bread-and-butter work for general practitioners.

One in seven school children and one in 25 adults are said to have asthma, so it ranks with ear infections, indigestion and headaches on a GP's list of "top 10" illnesses.

I work in a big, busy inner-city health centre and my impression is that although asthma has become more common over the past 15 years, the treatment has improved enormously over that period too. More patients have asthma, but their symptoms are under much better control. A wide variety of inhalers are now available to treat asthma attacks and, more importantly, to prevent asthma from causing symptoms at all.

Patients with mild asthma - those, for example,who get a little wheezy in the hay fever season or when a cat enters the room - will probably use a "reliever" inhaler that stops the wheezing almost immediately. For those with more serious asthma, the mainstay of treatment is a steroid inhaler to prevent wheezing before it starts.

Inhaled steroids have revolutionised the treatment of asthma. In my practice it has become a relatively rare event for a patient to need hospital admission for an asthma attack. The reason is that most of our asthmatic patients take their steroid "preventer" inhalers regularly. Hospital wards and casualty departments used to be full of such patients attached to nebulisers and intravenous drips. Inhaled steroids have changed allthat.

In the bad old days, asthma used to force children to miss classes for days and weeks because they were too wheezy and too short of breath to be able to get to school. Now, teenagers consider it "cool" to take their inhalers to school, and one drug company is exploiting this in its advertising campaign.

Steroids have had bad press because of their potential side effects - women growing beards, men growing breasts, children not growing at all. But with the help of groups such as the National Asthma Campaign, patients with asthma have discovered that inhaled steroids have almost no side-effects.

General practice asthma clinics run by practice nurses have played a part in the public education campaign that has helped to bring asthma under control. The NHS has paid family doctors financial incentives to set up asthma clinics.

If there is now a genuine downturn in the number of new asthmatics, it will be welcome news for patients, doctors and nurses. The NHS and the Treasury will be pleased too; asthma costs the health service £670m a year. The only people who might not be so pleased will be the manufacturers of asthma medications. For 15 years, their business has boomed, with new drugs, new inhalers and growing public awareness of the need to treat asthma aggressively.

But it is certainly much too early to predict the demise of asthma as a major public health problem. Despite the success of new inhalers, new drugs and plenty of health education, there were 1,584 deaths from asthma in 1997, the latest year for which figures are available. Each death is a reminder of how serious asthma can be.