title: Obtaining optimal control in mild asthma: theory and practice.
abstract: BACKGROUND
  Studies have shown that asthma severity is easily under-estimated and as a result, patients may be under-treated with reduced asthma control.
  
  
  OBJECTIVE
  This study, performed in the General Practice Research Database (GPRD), investigates asthma control in patients treated as intermittent asthmatics (short-acting beta agonist (SABA) alone), or persistent asthmatics (additional inhaled cortico-steroid (ICS), no other medication).
  
  
  METHODS
  Patients (0-45 years) diagnosed with asthma between 1 January 1995 and 31 December 2001 taking > or =2 scripts for SABA (SABA only group) or > or =3 scripts for ICS (ICS group) in the first six months following diagnosis were selected. Factors associated with drug prescriptions were assessed.
  
  
  RESULTS
  SABA script rates were 3.6 and 5.1 per year in the SABA and ICS group respectively, i.e. >1 dose/day. 10.5% of SABA group and 13.4% of ICS group used oral steroids. Within the SABA group, 37% were stepped up to ICS, the time to first ICS script being significantly associated with prior hospitalization (RR 2.26, CI 1.65-3.10) and atopy (RR 1.47, CI 1.33-1.63). A higher rate of oral steroid use was significantly associated with using ICS, being female, adult and smoking. Smokers and atopic individuals had increased risk of obtaining an earlier script for oral steroid (RR 1.32, CI 1.10-1.59 and RR 1.28, CI 1.10-1.49, respectively).
  
  
  CONCLUSIONS
  Asthma control was sub-optimal in a substantial proportion of patients using relatively high doses of SABA, or SABA and ICS from the outset of asthma treatment in general practice. Being female, atopic, a smoker and prior hospitalization were all associated with lack of asthma control and could guide physicians in treatment prescribing.
authors.affiliation: Department of Worldwide Epidemiology, GlaxoSmithKline, Greenford, Middlesex, UK. louise.x.watson@gsk.com
authors.forename: Louise
authors.initials: L
authors.lastname: Watson
authors.forename: Huib A M
authors.initials: HA
authors.lastname: Kerstjens
authors.forename: Klaus F
authors.initials: KF
authors.lastname: Rabe
authors.forename: Victor
authors.initials: V
authors.lastname: Kiri
authors.forename: George T
authors.initials: GT
authors.lastname: Visick
authors.forename: Dirkje S
authors.initials: DS
authors.lastname: Postma
mesh_terms: D000280:Administration, Inhalation; D000284:Administration, Oral; D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000627:therapeutic use; D000318:Adrenergic beta-Agonists / Q000008:administration & dosage / Q000627:therapeutic use*; D000328:Adult; D018927:Anti-Asthmatic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001249:Asthma / Q000188:drug therapy*; D002648:Child; D002675:Child, Preschool; D017723:Drug Utilization Review; D005194:Family Practice / Q000592:standards*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D010818:Practice Patterns, Physicians'; D006113:United Kingdom
chemical_list: D000305:Adrenal Cortex Hormones; D000318:Adrenergic beta-Agonists; D018927:Anti-Asthmatic Agents