title: Asthma-related resource use and cost by GINA classification of severity in three European countries.
abstract: BACKGROUND
  This study assessed the relationship between asthma burden and asthma severity in France, Italy, and Spain.
  
  
  METHODS
  Adult asthmatics, 18-55 years of age, completed a questionnaire while visiting a respiratory physician in 1998 and 1999. Asthma severity was categorized by physicians as intermittent, mild persistent, moderate persistent, or severe persistent according to Global Initiative for Asthma (GINA) guidelines.
  
  
  RESULTS
  Totals of 282 patients in France, 500 in Italy, and 296 in Spain entered the study. There were few differences between the three countries in the asthma symptom burden. Most patients with persistent asthma had used inhaled corticosteroids in the previous 14 days. Unexpectedly, 35% (Italy) to 83% (Spain) of patients with intermittent asthma also had used inhaled corticosteroids. In Spain, visits to the emergency department were more frequent (OR 7.0, 95% CI 4.9-10.0 with Italy as reference) and the costs of emergency care in all asthma severity categories were up to 10 times higher than in Italy and France. The frequency of hospitalizations did not differ systematically between the three countries.
  
  
  CONCLUSIONS
  Inadequate control of asthma symptoms among patients with severe persistent asthma could not be entirely explained by under-prescribing of asthma medications. The use of inhaled corticosteroids by patients with intermittent asthma might reflect misclassification of asthma severity, possibly due to difficulty in interpreting the GINA guidelines. The relatively high cost of emergency care in Spain does not appear to be related to greater asthma severity or poorer symptom control, but may be a feature of the Spanish health care system.
authors.affiliation: Pharmacoepidmiology Unit EA 3091, Centre Hospitalier Lyon-Sud, Sainte Eugenié (bat 5F), 69495 Pierre-Bénite, Cedex, France.
authors.forename: E
authors.initials: E
authors.lastname: Van Ganse
authors.forename: L
authors.initials: L
authors.lastname: Antonicelli
authors.forename: Q
authors.initials: Q
authors.lastname: Zhang
authors.forename: L
authors.initials: L
authors.lastname: Laforest
authors.forename: D D
authors.initials: DD
authors.lastname: Yin
authors.forename: G
authors.initials: G
authors.lastname: Nocea
authors.forename: V
authors.initials: V
authors.lastname: Sazonov Kocevar
mesh_terms: D000293:Adolescent; D000328:Adult; D001249:Asthma / Q000191:economics*; D015331:Cohort Studies; D017281:Cost of Illness; D005260:Female; D005602:France; D017048:Health Care Costs; D006301:Health Services Needs and Demand / Q000191:economics*; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D012720:Severity of Illness Index; D013030:Spain