title: Asthma under/misdiagnosis in primary care setting: an observational community-based study in Italy.
abstract: BACKGROUND
  Published data suggest that asthma is significantly under/misdiagnosed. The present community-based study performed in Italy aims at investigating the level of asthma under/misdiagnosis among patients referring to the General Practitioner (GP) for respiratory symptoms and undergoing Inhaled corticosteroids.
  
  
  METHODS
  A sub-analysis of a previously published observational cross-sectional study has been provided. It included subjects registered in the GP databases with at least three prescriptions of inhaled or nebulised corticosteroids during the 12 months preceding the start of the study. All subjects, independently of the diagnosis, were invited to visit their GP's office for a standardised interview and to fill the European Community Respiratory Health Survey (ECRHS) questionnaire.
  
  
  RESULTS
  The studies involved 540 GPs in most of the Italian regions and 2090 subjects (mean age 54.9 years, 54.1 % females) were enrolled. Among them 991 cases of physician-diagnosed asthma were observed while 1099 subjects received a diagnosis other than asthma (chronic obstructive pulmonary disease, chronic upper respiratory tract infections etc.). Among the lasts, the ECRHS questionnaire was suggestive for asthma diagnosis in 365 subjects (33.2 %).
  
  
  CONCLUSIONS
  The data suggest that there is still a large under/misdiagnosis of asthma in the Italian primary care setting, despite the spread of GINA guidelines nearly 20 years before this study. A validated tool like the ECRHS questionnaire has detected a considerable proportion of potentially asthmatic patients who should be addressed to lung function assessment to confirm the diagnosis. Further educational efforts directed to the GPs are needed to improve their diagnosis of asthma (SAM104964).
authors.affiliation: Medical and Scientific Department, GlaxoSmithKline, Verona, Italy.
authors.forename: Maria Sandra
authors.initials: MS
authors.lastname: Magnoni
authors.affiliation: Allergy Unit, Verona University and General Hospital, Piazzale Stefani 1, 37126 Verona, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Caminati
authors.affiliation: Allergy Unit, Verona University and General Hospital, Piazzale Stefani 1, 37126 Verona, Italy.
authors.forename: Gianenrico
authors.initials: G
authors.lastname: Senna
authors.affiliation: Medical and Scientific Department, GlaxoSmithKline, Verona, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Arpinelli
authors.affiliation: Medical and Scientific Department, GlaxoSmithKline, Verona, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Rizzi
authors.affiliation: Allergy Unit, Verona University and General Hospital, Piazzale Stefani 1, 37126 Verona, Italy.
authors.forename: Anna Rita
authors.initials: AR
authors.lastname: Dama
authors.affiliation: Allergy Unit, Verona University and General Hospital, Piazzale Stefani 1, 37126 Verona, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Schiappoli
authors.affiliation: Società Italiana di Medicina Generale, Florence, Italy.
authors.forename: Germano
authors.initials: G
authors.lastname: Bettoncelli
authors.affiliation: Dipartimento di Scienze Mediche, Sezione di Medicina Interna e Cardiorespiratoria, Centro Interdipartimentale per lo Studio delle Malattie Infiammatorie delle Vie Aeree e Patologie Fumo-Correlate (CEMICEF, formerly termed Centro), Università di Ferrara, Ferrara, Italy.
authors.forename: Gaetano
authors.initials: G
authors.lastname: Caramori
keywords: Asthma; ECRHS questionnaire; Misdiagnosis; Primary care; Under diagnosis