Inadequate outpatient medical therapy for patients with asthma admitted to two urban hospitals

Inadequate antiasthma drug use in the north of Italy

“…Inadequacies of medical therapy and education have been recently reported in an American study on asthmatic out-patients [8]. Less than one half of patients affected by moderate-to-severe asthma who were admitted to hospital for an exacerbation of asthma had been prescribed inhaled anti-inflammatory drugs.…”

“…A number of studies have attempted to shed light on asthma care in different countries by using data from general practice registers, national medical expenditures and indirect costs, antiasthma drug sales, pharmacists or community pharmacy records [3][4][5][6]. The estimates drawn from these studies are inevitably approximate.More recently, this issue has been better approached by measuring antiasthmatic drug consumption and the use of healthcare resources by asthmatic patients identified through adequate epidemiological or clinical surveys [7,8].Based on the results of a screening questionnaire administered in the first phase of the European Community Respiratory Health Survey (ECRHS), a multicentre survey of the prevalence, determinants and management of asthma [9,10], we found Italy to be one of the countries with the lowest ratio (0.54) between subjects declaring current consumption of antiasthmatic drugs and those reporting asthma attacks during the previous 12 months [11,12]. In the second phase of the ECRHS, carried out in three Italian cities (Pavia, Turin and Verona), a standardized clinical interview was used to improve the identification of asthmatic subjects and to obtain a more precise estimate of antiasthmatic drug consumption.…”

“…More recently, this issue has been better approached by measuring antiasthmatic drug consumption and the use of healthcare resources by asthmatic patients identified through adequate epidemiological or clinical surveys [7,8].…”

Strategies Used by Older Adults with Asthma for Adherence to Inhaled Corticosteroids

“…8 Approximately two-thirds of asthma-related deaths in the U.S. occur among adults over age 55. 8 While studies of older asthmatics have identified characteristics that distinguish adherent and non-adherent patients, 5,[9][10][11][12][13] little has been published on specific mechanisms employed by patients to achieve and maintain adherence, and none have addressed strategies used by older adults who may differ in their ICS use from younger adults because of the greater prevalence of polypharmacy in this population. 14 One study of HIV-seropositive individuals found that adherence improved when pill-taking was linked to daily activities such as eating breakfast, watching a favorite television program, attending weekly meetings and sleeping at home.…”

Planning for Action: The Impact of an Asthma Action Plan Decision Support Tool Integrated into an Electronic Health Record (EHR) at a Large Health Care System

“…10 Although provision of an AAP to every patient with asthma is considered to be the standard of care, provider compliance with this recommendation has been limited. [12][13][14][15][16][17] Barriers to provider compliance include lack of time, inexperience, and insufficient confidence in generating appropriate recommendations, as well as perceptions that patients may be nonadherent to AAPs or unable to self-manage. 18,19 Providers also underutilize other recommendations in the NHLBI's guidelines, including assessments of asthma severity and control and the stepwise approach to managing asthma when choosing medication options for their patients.…”