A multinational study of treatment failures in asthma management.
METHODS
Emergency rooms.


OBJECTIVE
To assess quality of care and its determinants for asthma patients before emergency room treatment.


METHODS
Consecutive patients with acute severe asthma attending emergency rooms were questioned about the severity of their disease and treatment in the previous 4 weeks. Prescriptions of inhaled corticosteroids were recorded. Other outcomes included self-reported adherence to treatment and loss of work.


RESULTS
Thirteen centres in 11 countries recruited 1156 patients. Only 36% of patients with persistent asthma had been prescribed an adequate dose of inhaled corticosteroids. This percentage improved in those receiving regular care from the same doctor (OR 2.86, 95%CI 1.38-5.96), and was at least as good for the 10% of patients receiving 'private' health care (OR 3.08, 95%CI 1.69-5.62). Forty-four per cent of patients had health insurance covering some asthma medications. These patients were more likely to be receiving adequate inhaled corticosteroids (OR 1.74, 95%CI 1.17-2.58), and reported better adherence than those without insurance (OR 3.00, 95%CI 1.64-5.50). Of those on adequate inhaled corticosteroids, 18% had lost work in each of the 4 previous weeks compared with 59% among those more than one treatment step below the recommended dose.


CONCLUSIONS
Access to adequate treatment is critical for better management of asthma.
Burney
P
P
Department of Respiratory Epidemiology and Public Health, National Heart and Lung Institute, Imperial College, London, UK. p.burney@imperial.ac.uk
Potts
J
J
Aït-Khaled
N
N
Sepulveda
R M D
RM
Zidouni
N
N
Benali
R
R
Jerray
M
M
Musa
O A A
OA
El-Sony
A
A
Behbehani
N
N
El-Sharif
N
N
Mohammad
Y
Y
Khouri
A
A
Paralija
B
B
Eiser
N
N
Fitzgerald
M
M
Abu-Laban
R
R
D000041:Absenteeism; D000208:Acute Disease; D000280:Administration, Inhalation; D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018927:Anti-Asthmatic Agents / Q000008:administration & dosage*; D001249:Asthma / Q000188:drug therapy* / Q000453:epidemiology; D003133:Commission on Professional and Hospital Activities / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009313:National Health Programs / Q000706:statistics & numerical data; D010043:Outcome and Process Assessment, Health Care / Q000706:statistics & numerical data*; D010349:Patient Compliance / Q000706:statistics & numerical data; D012720:Severity of Illness Index; D017211:Treatment Failure
D000305:Adrenal Cortex Hormones; D018927:Anti-Asthmatic Agents