title: Limited treatment adaptation despite poor asthma control in asthma patients treated with inhaled corticosteroids.
abstract: OBJECTIVE
  Current asthma guidelines recommend use of inhaled corticosteroids (ICS) in patients with persistent disease. This study was designed to investigate (1) the proportion of patients prescribed ICS-containing maintenance treatment who achieve asthma control, (2) determinants of control and (3) how physicians adapt treatment to the level of control.
  
  
  METHODS
  General practitioners (GPs) and chest physicians (CPs) in France recruited patients consulting for asthma and prescribed an ICS. Over a 2-year follow-up period, asthma symptoms in the previous 3 months and treatments prescribed were documented at each visit. Variables independently associated with asthma control were determined by multiple logistic regression.
  
  
  RESULTS
  Data were available for 924 patients recruited by GPs and 455 recruited by CPs. Asthma control was acceptable in only 24% of patients at inclusion, and in 33.6% at the last follow-up visit. Five factors were independently associated with asthma control: age (or time since diagnosis), gender, smoking status, allergic aetiology of asthma and treatment. Most patients (56.3%) were prescribed the same ICS dose regimen at the end of follow-up as at inclusion. The intensity of controller therapy had been increased in only 12.2% of patients unacceptably controlled at inclusion.
  
  
  CONCLUSIONS
  Asthma was unacceptably controlled in most patients receiving ICS-containing maintenance treatment and remained so during follow-up. Despite this, treatment adaptations by GPs and CPs were very infrequent. This unsatisfactory situation may be improved by adopting a more dynamic approach to tailoring controller therapy to the needs of the patient.
authors.affiliation: a Respiratory and Intensive Care Medicine, Hôpital Cochin - Site Val de Grâce, Université Paris-Descartes , AP-HP, Paris , France .
authors.forename: Nicolas
authors.initials: N
authors.lastname: Roche
authors.affiliation: b GlaxoSmithKline , Marly-le-Roi , France .
authors.forename: Céline
authors.initials: C
authors.lastname: Pribil
authors.affiliation: c Laboratory of Pulmonary Pharmacology UPRES EA220 , Hôpital Foch, University of Versailles-Saint Quentin en Yvelines , Suresnes , France .
authors.forename: Philippe
authors.initials: P
authors.lastname: Devillier
authors.affiliation: d Pharmacoepidemiology Unit, UMR CNRS 5558, University of Lyon , Lyon , France , and.
authors.forename: Eric
authors.initials: E
authors.lastname: Van Ganse
authors.affiliation: e Kappa Santé , Paris , France.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Schück
authors.affiliation: e Kappa Santé , Paris , France.
authors.forename: Johanna
authors.initials: J
authors.lastname: Doussaint
authors.affiliation: e Kappa Santé , Paris , France.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Martin
authors.affiliation: b GlaxoSmithKline , Marly-le-Roi , France .
authors.forename: Gaëlle
authors.initials: G
authors.lastname: Nachbaur
authors.affiliation: b GlaxoSmithKline , Marly-le-Roi , France .
authors.forename: Isabelle
authors.initials: I
authors.lastname: Boucot
mesh_terms: D000280:Administration, Inhalation; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D058666:Adrenergic beta-2 Receptor Agonists / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D018927:Anti-Asthmatic Agents / Q000627:therapeutic use*; D001249:Asthma / Q000188:drug therapy* / Q000453:epidemiology; D005260:Female; D005602:France / Q000453:epidemiology; D058005:General Practitioners; D006801:Humans; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D013038:Specialization; D016896:Treatment Outcome
chemical_list: D000305:Adrenal Cortex Hormones; D058666:Adrenergic beta-2 Receptor Agonists; D018927:Anti-Asthmatic Agents
keywords: Asthma; asthma control; inhaled corticosteroids; treatment adaptation