Application and implementation of the GINA asthma guidelines by specialist and primary care physicians: a longitudinal follow-up study on 264 children.
OBJECTIVE
To implement GINA guidelines and to assess their impact on the management of childhood asthma.


METHODS
A working group of primary care physicians (PCPs) and specialists developed a GINA-based clinical pathway. We then monitored the impact on 385 children (aged 0-15 years) referred to the respiratory outpatients clinic at the University Children's Hospital, Brescia, Italy by 179 PCPs between September 2003 and July 2005.


RESULTS
Mean follow-up for 264 children with complete datasets was 10 months. Guidelines were followed by 94.6% of the PCPs. 98.6% of children learned to manage exacerbations. Half of the patients with persistent symptoms became intermittently symptomatic. Maintenance treatment was suspended in 47.2%, reduced in 27.6%, and increased in 4.9%. Asthma severity diminished (p<0.0001) and requirement for medication for exacerbations was significantly reduced (p<0.0001).


CONCLUSIONS
Regular specialist visits, a website, and a written management plan shared by all those involved, led to clinical improvements as well as a reduction in, and more efficient use of, asthma medication.
Laboratorio Clinico-Pedagogico e Ricerca Biomedica, Ospedale dei Bambini, Brescia, Italy. guarnacc@med.unibs.it
Sebastiano
S
Guarnaccia
Andrea
A
Lombardi
Alessandro
A
Gaffurini
Mariateresa
M
Chiarini
Serena
S
Domenighini
Emanuele
E
D'Agata
Richard Fabian
RF
Schumacher
Raffaele
R
Spiazzi
Luigi D
LD
Notarangelo
D000293:Adolescent; D001249:Asthma / Q000175:diagnosis* / Q000628:therapy; D002648:Child; D002675:Child, Preschool; D032921:Consensus; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007558:Italy; D008137:Longitudinal Studies; D008297:Male; D008511:Medicine; D009330:Nebulizers and Vaporizers; D010346:Patient Care Management / Q000592:standards*; D010820:Physicians; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care; D012720:Severity of Illness Index; D013038:Specialization; D013147:Spirometry