title: Are the asthma guideline goals achieved in daily practice? A population-based study on treatment adequacy and the control of asthma.
abstract: BACKGROUND
  The guidelines for asthma recommend that the use of anti-inflammatory therapy should be adapted to the severity of the disease. However, few data are available to assess the adequacy of the use of drugs and its influence on the control of asthma in 'real life'.
  
  
  METHODS
  The adequacy of the current use of anti-asthmatic medication according to the Global Initiative for Asthma (GINA) guidelines was assessed in a random sample of 400 asthmatics identified in the frame of the Italian Study on Asthma in Young Adults. Asthma severity was assessed using the GINA criteria; accordingly, a patient was classified as receiving inadequate treatment if his/her current use of drugs was lower than that suggested by the guidelines for the corresponding severity level. The absence of asthma attacks in the last 3 months was used as an indicator of the disease control.
  
  
  RESULTS
  Fifty-five percent of the patients had persistent asthma. Overall, 48% (95% CI 41.2-54.8) of persistent asthmatics were receiving inadequate treatment, and 66% (95% CI 59.5-72.4) had not used their medication daily over the past 3 months. Persistent asthmatics who were inadequately treated had a significantly greater frequency of asthma attacks (geometric mean ratio 3.7; 95% CI 2.1-6.6) than those using an adequate dose of medication. Mild and moderate persistent asthmatics using an adequate medication regimen reported a low number of asthma attacks (median 0). At the multivariate analysis, a good control of the disease was positively associated with an adequate dose of anti-inflammatory medication (OR = 2.2; 95% CI 1.1-4.5) and was negatively associated with a later onset of asthma (OR = 0.96; 95% CI 0.93-0.99) and severe asthma (OR = 0.37; 95% CI 0.17-0.81).
  
  
  CONCLUSIONS
  Despite the increase in the use of inhaled corticosteroids, half of the persistent asthmatics from the general population are using a medication regimen below their severity level. When the use of drugs follows the GINA guideline recommendations, a good control of asthma is also achievable in the daily management of the disease, particularly in the case of mild and moderate asthmatics.
authors.affiliation: Unit of Epidemiology and Medical Statistics, Department of Medicine and Public Health, University of Verona, Verona, Italy. demarco@biometria.univr.it
authors.forename: Roberto
authors.initials: R
authors.lastname: de Marco
authors.forename: Lucia
authors.initials: L
authors.lastname: Cazzoletti
authors.forename: Isa
authors.initials: I
authors.lastname: Cerveri
authors.forename: Angelo
authors.initials: A
authors.lastname: Corsico
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Bugiani
authors.forename: Simone
authors.initials: S
authors.lastname: Accordini
authors.forename: Laura
authors.initials: L
authors.lastname: Carrozzi
authors.forename: Rossano
authors.initials: R
authors.lastname: Dallari
authors.forename: Aldo
authors.initials: A
authors.lastname: De Togni
authors.forename: Alessandra
authors.initials: A
authors.lastname: Marinoni
authors.forename: Pietro
authors.initials: P
authors.lastname: Pirina
authors.forename: Christer
authors.initials: C
authors.lastname: Janson
mesh_terms: D000328:Adult; D018927:Anti-Asthmatic Agents / Q000627:therapeutic use*; D001249:Asthma / Q000188:drug therapy* / Q000453:epidemiology / Q000517:prevention & control; D005260:Female; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D011153:Population; D017410:Practice Guidelines as Topic; D016896:Treatment Outcome
chemical_list: D018927:Anti-Asthmatic Agents