Asthma management in real life; preliminary data from CPD-ARGA project

Background:

Despite asthma control and treatment adherence have been largely investigated in current literature, the appropriateness of general practitioner in prescribing for patients with asthma is less studied. At the beginning of a continuing professional development (CPD) program on rhinitis and asthma, part of ARGA (Allergopatie Respiratorie studio di monitoraggio linee-guida GINA e ARIA), a study supported by Italian Drug Agency (AIFA), the drugs prescription and the healthcare resource utilization of physicians adhering to the study were performed.

Materials and Methods:

We observed 70.147 patients followed by 60 GP during 2006. 709 patients had diagnosis of asthma. 68 patients were hospitalized for asthma exacerbations, mean age 51 yrs. Among these patients only 16 were treated with association of beta 2 agonist/inhaled steroid coupled with antileukotrienes (9/16), antihistamines (8/16), theophylline (4/16). Systemic steroids (prednisone, betamethasone) were prescribed to 10 patients, among them, 3 received no other therapy, other 3 patients received only oral antihistamines. In 4/16 patients were prescribed tiotropium although asthma indication is not approved. The total amount of prescribed asthma drugs for these patients was low, it could last for a maximum of two months. The most prescribed drugs were beta 2 short acting bronchodilators (up to 22 drug boxes for a patient). No patient was evaluated by a specialist (allergist or pneumonologist) before hospitalization; only 6 were visited by a specialist after their discharge from the hospital and 11 underwent a spirometric evaluation. 7 patients were hospitalized twice in a year.

Conclusion:

Regardless of the efforts of national and international societies for the diffusion of asthma diagnosis and treatment guidelines, asthma is still undervalued and untreated by general practitioners; this could be the principal cause of hospitalization for asthma exacerbation in the observed group of patients. It could be interesting to evaluate in a CPD blended program (5 residential plus 4 distance learning courses) in which the contents are tailored on physicians knowledge, which healthcare resource utilisation and drugs prescription would be able to improve the asthma management.