title: Persistence with asthma treatment is low in Germany especially for controller medication - a population based study of 483,051 patients.
abstract: BACKGROUND
  The objective of the present analysis was to evaluate treatment patterns and persistence with treatment of an unselected patient population with a diagnosis of asthma.
  
  
  METHODS
  The database of the Bavarian statutory health insurance physician's association (Kassenärztliche Vereinigung) covering 83% of the population was analyzed for an index period from April 2005 to March 2006. Defined daily doses (DDDs) were used to quantify treatment persistence. Results were compared with recent guidelines.
  
  
  RESULTS
  The prevalence of physician diagnosed asthma in Bavaria was 4.8% in females and 4.5% in males; only 61.4% of these patients (of a total of n = 483,051) received any anti-asthmatic pharmacotherapy; 68.3% received medical care from their general practitioner, and 8.3% from a pulmonologist alone. Most patients (65.1%) received no more than 90 DDDs of controller medication in the index period of 365 days, only about 1% received medication for the complete index period. Long- (40.1%) and short-acting beta(2)-agonists (65.6%) were used more frequently than inhaled corticosteroids (ICS). 52.8% of asthma patients were treated in accordance with guidelines.
  
  
  CONCLUSIONS
  Persistence of asthma patients with medical treatment is low, especially for controller medication. The discrepancy between current knowledge, guidelines and clinical practice is substantial and may question the value of current guidelines for the treatment of patients with asthma in ambulatory care. In addition, the results of this study cast doubt on the impact of contemporary treatment on the decline of asthma mortality seen in recent years in Germany.
authors.affiliation: Institut für Medizinische Informationsverarbeitung, Biometrie und Epidemiologie, University of Munich, Munich, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Hasford
authors.forename: J
authors.initials: J
authors.lastname: Uricher
authors.forename: M
authors.initials: M
authors.lastname: Tauscher
authors.forename: P
authors.initials: P
authors.lastname: Bramlage
authors.forename: J C
authors.initials: JC
authors.lastname: Virchow
mesh_terms: D000280:Administration, Inhalation; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage; D000318:Adrenergic beta-Agonists / Q000008:administration & dosage; D000328:Adult; D018927:Anti-Asthmatic Agents / Q000008:administration & dosage*; D001249:Asthma / Q000188:drug therapy* / Q000453:epidemiology; D005260:Female; D005858:Germany; D019983:Guideline Adherence; D017408:Guidelines as Topic; D006801:Humans; D008297:Male; D010818:Practice Patterns, Physicians'; D015995:Prevalence; D055815:Young Adult
chemical_list: D000305:Adrenal Cortex Hormones; D000318:Adrenergic beta-Agonists; D018927:Anti-Asthmatic Agents