IRISH THORACIC SOCIETY Proceedings of Annual Scientific Meeting held in Dublin on 4th & 5th November, 1994 ASTHMA IN IRELAND: HOW WELL IS IT MANAGED? A PRELIMINARY REPORT OF A COMMUNITY SURVEY THROUGH PHARMACIES T. Feeney, O. O'Muire, J. J. Gilmartin. On behalf of the medical committee of the Asthma Society of Ireland, 24 Anglesea Street, Dublin 2. Since the publication of international guidelines for asthma management there has been considerable interest in audit in asthma. To date there has been no community audit of asthma management in Ireland. The Asthma Society of Ireland therefore undertook a community based survey through Irish pharmacies over 7 days ending 30th May 1994. Twenty-five pharmacies were selected to represent the national demographic profile. All prescriptions for asthma medicines were eligible for inclusion. Twenty-three questions were delivered by the pharmacist to define patient details and overall management of disease in the previous year. To assess understanding of the different types of treatment patients were asked to identify "reliever" or "preventer" from a series of photos. Of 486 patients 285 had complete data. The high loss was due to a surprising 25% of prescriptions being collected on behalf of patients 59% of patients held medical cards. 72% of patients were managed by their GP alone with 23% having combined GP/specialist care. 66% were taking preventative therapy. Whereas 48% of patients had taken inhaled steroids in the past year, an amazing 50% had at least one crash course of oral steroids over the same period and 15% were on regular oral steroids. All patients had their peak flow measured at sometime but 18% had never had their inhaler technique assessed. 29 of those 189 on preventative therapy misidentified a reliever as a preventer. Of the 33 patients overusing beta- agonists only 5 were not on regular preventative therapy. 16% were using a nebuliser regularly. 22% of all patients missed 2 weeks off work or school. 67% of patients were happy with their understanding of their illness. In conclusion patients were generally well informed but had fears about inhaled steroids high proportion of patients were taking oral steroids indicating sub optimal control. Beta-agonist overuse was relatively uncommon. It was disappointing that so few patients had their technique checked. Strategies to deal with these deficiencies will be discussed. Study kindly grant aided by Allen & Hanburys. GEOGRAPHICAL VARIATION AND TIME TRENDS IN ASTHMA MORTALITY IN THE REPUBLIC OF IRELAND P. Manning, H. Sinclair, L. Clancy. St. James's Hospital, Dublin. The Republic of Ireland has one of the highest mortality rates for asthma in children and young adults (5-44 years) in the European Community (EC). 1 Deaths from asthma in this age group are considered to be largely avoidable. 2 This paper examines the geographical variation in asthma mortality and how these deaths have changed nationally and locally by health board area in the Republic of Ireland. Age standardized mortality ratios (SMRs) and 95% confidence 'intervals for asthma in the age group 5-44 years were calculated for 3 five year periods 1974-78, 1980-84 and 1986-90. The small number of asthma deaths in this age group necessitated the aggregation of data over these five year periods. In the time periods 1974-78 and 1980-84 no SMR was significantly higher than the average for that period, though wide variation did exist between health boards. In the time period 1986-90 two health board areas, the Midland Health Board (MHB) and North Eastern Health Board (NEHB), had SMRs significantly higher than the national average [MHB: SMR = 219 (CI 119-366); NEHB: SMR = 176 (CI 103-282)]. This time period also had the widest geographical variation in asthma mortality. When the overall national asthma mortality was examined for all three time periods combined, there was a small but steady rise in mortality. However, analysis by health board area showed widely differing trends. Only the North Eastern Health Board experienced a steady increase in mortality. The SMR for this health board was significantly raised in the most recent time period compared with the average for the whole period [SMR = 202, (CI 117-323)]. The Midland Health Board also experienced a significant rise in asthma mortality in recent years [SMR = 250, (CI 137-420)]. This data shows that there is increase in the geographical variation in asthma mortality in recent years, particularly in the MHB and NEHB areas. The reason for this increase in asthma mortality is unclear and requires further investigation. Reference 1. Holland, W. W., ed. European Community atlas of'avoidable death'. 2nd ed., Vol. 1. Oxford University Press, 1991. THE PATHOPHYSIOLOGICAL BASIS OF PERSISTENT NON-PRODUCTIVE COUGH: ABNORMAL INTRA- EPITHELIAL NERVES MAY EXPLAIN THE SENSORY TUSSIVE HYPER-RESPONSIVENESS F. O'Connell, D. R. Springall, J. M. Polak, V. E. Thomas, R. W. Fuller, N. B. Pride. Departments of Clinical Pharmacology, Medicine and Histochemistry, Royal Postgraduate Medical School, Hammersmith Hospital, London, England. The pathogenesis of persistent non-productive cough (PNPC) is poorly understood: In contrast to productive cough, where excess airway secretions provide the stimulus to cough, patients with non-productive cough do not expectorate excess secretions, suggesting that the stimulus to cough lies in enhanced sensitivity of afferent airway nerves. The aim of this study was to assess the sensitivity of airway nerves, using capsaicin challenge, in patients with PNCP, to assess the effects of treatment, and to assess intraepithelial nerve density in patients with idiopathic PNCP. In 87 consecutive, unselected referrals with PNCP, the cause of cough was investigated and treated according to a standard clinical protocol. Cough sensitivity to inhaled capsaicin, which was enhanced at presentation, returned to 158