title: Asthma control in Europe: a real-world evaluation based on an international population-based study.
abstract: BACKGROUND
  Epidemiologic evidence related to asthma control in patients from the general population is scanty.
  
  
  OBJECTIVE
  We sought to assess asthma control in several European centers according to the Global Initiative for Asthma (GINA) guidelines and to investigate its determinants.
  
  
  METHODS
  In the European Community Respiratory Health Survey II (1999-2002), 1241 adults with asthma were identified and classified into inhaled corticosteroid (ICS) users and non-ICS users in the last year. Control was assessed in both groups by using the GINA proposal (controlled, partly controlled, and uncontrolled asthma), and it was related to potential determinants.
  
  
  RESULTS
  Only 15% (95% CI, 12% to 19%) of subjects who had used ICSs in the last year and 45% (95% CI, 41% to 50%) of non-ICS users had their asthma under control; individuals with uncontrolled asthma accounted for 49% (95% CI, 44% to 53%) and 18% (95% CI, 15% to 21%), respectively. Among ICS users, the prevalence of uncontrolled asthma showed great variability across Europe, ranging from 20% (95% CI, 7% to 41%; Iceland) to 67% (95% CI, 35% to 90%; Italy). Overweight status, chronic cough and phlegm, and sensitization to Cladosporium species were associated with poor control in ICS users. About 65% and 87% of ICS users with uncontrolled and partly controlled asthma, respectively, were on a medication regimen that was less than recommended by the GINA guidelines.
  
  
  CONCLUSIONS
  Six of 7 European asthmatic adults using ICSs in the last year did not achieve good disease control. The large majority of subjects with poorly controlled asthma were using antiasthma drugs in a suboptimal way. A wide variability in asthma control emerged across Europe.
  
  
  CONCLUSIONS
  Greater attention should be paid to asthma management and to the implementation of the GINA guidelines.
authors.affiliation: Unit of Epidemiology and Medical Statistics, Department of Medicine and Public Health, University of Verona, Verona, Italy. lucia.cazzoletti@univr.it
authors.forename: Lucia
authors.initials: L
authors.lastname: Cazzoletti
authors.forename: Alessandro
authors.initials: A
authors.lastname: Marcon
authors.forename: Christer
authors.initials: C
authors.lastname: Janson
authors.forename: Angelo
authors.initials: A
authors.lastname: Corsico
authors.forename: Deborah
authors.initials: D
authors.lastname: Jarvis
authors.forename: Isabelle
authors.initials: I
authors.lastname: Pin
authors.forename: Simone
authors.initials: S
authors.lastname: Accordini
authors.forename: Enrique
authors.initials: E
authors.lastname: Almar
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Bugiani
authors.forename: Adriana
authors.initials: A
authors.lastname: Carolei
authors.forename: Isa
authors.initials: I
authors.lastname: Cerveri
authors.forename: Enric
authors.initials: E
authors.lastname: Duran-Tauleria
authors.forename: David
authors.initials: D
authors.lastname: Gislason
authors.forename: Amund
authors.initials: A
authors.lastname: Gulsvik
authors.forename: Rain
authors.initials: R
authors.lastname: Jõgi
authors.forename: Alessandra
authors.initials: A
authors.lastname: Marinoni
authors.forename: Jesús
authors.initials: J
authors.lastname: Martínez-Moratalla
authors.forename: Paul
authors.initials: P
authors.lastname: Vermeire
authors.forename: Roberto
authors.initials: R
authors.lastname: de Marco
mesh_terms: D000328:Adult; D000485:Allergens / Q000009:adverse effects; D000818:Animals; D001249:Asthma / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology*; D003430:Cross-Sectional Studies; D019468:Disease Management; D005062:European Union; D005260:Female; D006801:Humans; D008297:Male; D017410:Practice Guidelines as Topic / Q000592:standards; D015995:Prevalence; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires
chemical_list: D000485:Allergens