Aims: To quantify use of high dose inhaled corticosteroids (ICS) and add-on therapy in adults, and children aged 12 and over, in the community. Methods: Cross-sectional observational survey of UK general practice prescribing records from July 2002 to June 2003 utilising the Doctors Independent Network clinical database. Results: 30,895 patients aged 12 and over were treated for asthma with inhaled corticosteroids, with a quantifiable daily dose recommendation in 22,027 cases. Twenty-seven

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... t (95% Confidence Intervals 26-28%) were prescribed 'highdose' ICS (>800 mcg/day beclomethasone or equivalent). Of these, 32% (31-33%) were not currently prescribed add-on therapy (long acting B2 agonists, leukotriene antagonists, theophylines), and most of these (84%, 82-86%) had never received a prior trial of add-on therapy. Conclusions: High dose ICS therapy was commonly prescribed to people with asthma, frequently without co-prescribed add-on therapy. Many adults with more severe asthma may be receiving treatment that does not accord with current evidence of best practice. (M. Thomas). inflammatory medication. Inhaled corticosteroids (ICS) are the principal anti-inflammatory agents used in persistent asthma [2] [3] [4] and have an excellent efficacy and safety profile in moderate doses [5] [6] [7] . As well as improving symptoms and lung function [6, 7] , ICS have been shown to protect against hospitalization [8] and mortality [9] . Due to concerns about the steroid-related adverse events associated with systemic absorption [6]