Undertreatment in a nonselected population of adult patients with asthma☆, ☆☆, ★, ★★

Bousquet, Jean; Knani, J.; Henry, C. J. K.; Liard, R; Richard, A; Michel, F. B.; Neukirch, Françoise

doi:10.1016/s0091-6749(96)70084-2

Cited by 94 publications

(57 citation statements)

References 48 publications

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“…In accordance with audits of asthma care [104] and statistics from drug sales [8], the treatment of asthma varies widely between the ECRHS centres [17,20]. The ECRHS has also shown that, at least at the time of the study, asthma was still often undertreated [20,93,95].…”

Section: Resultsmentioning

confidence: 99%

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The European Community Respiratory Health Survey: what are the main results so far?

et al. 2001

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The European Community Respiratory Heath Survey (ECRHS) was the first study to assess the geographical variation in asthma and allergy in adults using the same instruments and definitions. The database of the ECRHS includes information fromy140,000 individuals from 22 countries. The aim of this review is to summarize the results of the ECRHS to date.The ECRHS has shown that there are large geographical differences in the prevalence of asthma, atopy and bronchial responsiveness, with high prevalence rates in English speaking countries and low prevalence rates in the Mediterranean region and Eastern Europe. Analyses of risk factors have highlighted the importance of occupational exposure for asthma in adulthood. The association between sensitization to individual allergens and bronchial responsiveness was strongest for indoor allergens (mite and cat). Analysis of treatment practices has confirmed that the treatment of asthma varies widely between countries and that asthma is often undertreated.In conclusion, the European Community Respiratory Health Survey has shown that the prevalence of asthma varies widely. The fact that the geographical pattern is consistent with the distribution of atopy and bronchial responsiveness supports the conclusion that the geographical variations in the prevalence of asthma are true and most likely due to environmental factors. Eur Respir J 2001; 18: 598-611. During the first half of the 1990s, information on the variation in asthma prevalence, known or suspected risk factors for atopy and asthma, and information on the management of asthma in young adults was collected in the European Community Respiratory Health Survey (ECRHS).The reason for undertaking the ECRHS was a rapid increase in the prevalence of asthma that had been reported from many different countries [1][2][3][4]. This increase was over too short a time period to be explained by genetic factors and must therefore have been related to nongenetic or environmental changes. Further evidence of the importance of environmental factors in asthma was that studies comparing prevalence in urban and rural areas in developing countries had shown large differences in asthma prevalence [5][6][7]. Treatment patterns of asthma [8] and asthma mortality [9] had been found to vary considerably in Europe which raised the question of whether the variation in mortality was due to geographical differences in the prevalence of asthma or differences in asthma fatality. Research directed towards identifying the environmental factors that explain this geographical variation in asthma was required to identify potential strategies to counter the global increase in the prevalence of asthma.The information available on the variation in the prevalence of asthma and allergy at the beginning of the 1990s had been collected through several studies using different protocols. The ECRHS was, therefore, the first study that assessed the prevalence of asthma and allergic disease in a large number of countries

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Section: Resultsmentioning

confidence: 99%

“…In a study from two French centres, 136 patients with asthma were identified [93]. An asthma severity score based on number of asthma attacks, symptoms, FEV1 and treatment was developed and validated.…”

Section: Treatment Practicesmentioning

confidence: 99%

The European Community Respiratory Health Survey: what are the main results so far?

et al. 2001

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“…Even in developed countries, where the access to the health system and medications is effectively possible, various reports in the literature indicate a rate of compliance of approximately 50%. (13,(21)(22) In the present study, compliance with treatment was not evaluated, since we considered the treatment reported by the patient, and this does not necessarily imply that it was the treatment prescribed. It is possible that our results reflect a combination of these factors.…”

Section: Discussionmentioning

confidence: 99%

Estudo comparativo entre o manejo da asma em uma unidade de referência da rede pública de Porto Alegre (RS) e as proposições do III Consenso Brasileiro no Manejo da Asma

et al. 2006

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Objective: To determine whether the guidelines put forth in the ΙΙΙ Brazilian Consensus on Asthma Management are being applied in a population of asthma patients treated at a public hospital that is a referral center for asthma in the city of Porto Alegre, Brazil. Methods: All adult asthma patients who began their treatment between 1999 and 2002 were evaluated. The treatment given was classified as consistent or inconsistent with the Consensus guidelines. The clinical features of asthma and the frequency of treatment provided by a specialist were compared between the two groups (those receiving guideline-consistent treatment and those receiving guideline-inconsistent treatment). Results:The charts of 357 patients were evaluated. The study sample consisted of 106 males (29.9%) and 251 females (70.3%). The mean age was 41 years, and 33 (9.2%) of the patients were smokers. The treatment was considered inconsistent with the Consensus guidelines in 246 cases (70%). Of those 246, 174 (71%) had presented persistent asthma and were not treated with an inhaled corticosteroid. Normal forced expiratory volume in one second, being from 12 to 18 years of age, and having intermittent asthma were more frequently observed among the patients receiving guideline-consistent treatment (p < 0.01). No correlations were found between guideline-inconsistent treatment and being treated by a pulmonologist, severity of persistent asthma or number of emergency room visits. Conclusion: Most of the asthma patients treated at the public referral center in Porto Alegre did not receive treatment that was consistent with the Consensus guidelines. Undertreatment with inhaled corticosteroids was the principal source of that inconsistency.

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“…These findings, however, are not exclusive to developing countries, since the present observations are similar to those of LEWIS et al [15] in a clinical trial dealing with poor Hispanic children in Los Angeles, USA. Moreover, BOUSQUET et al [20] who studied a nonselected population of adult patients with asthma, reported that among the patients with severe asthma, 85% of the patients from Paris and 60% from Montpellier were not receiving an anti-inflammatory treatment.…”

Section: Discussionmentioning

confidence: 99%

Are International Asthma Guidelines effective for low-income Brazilian children with asthma?

Cabral¹,

Carvalho²,

Chinen³

et al. 1998

Eur Respir J

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The present study was designed to evaluate the effectiveness of International Asthma Guidelines in low-income asthmatic children in the city of Sao Paulo, Brazil. Fifty children with moderate or severe asthma were evaluated. Patients were evaluated before and after a 1 yr follow-up period using a pre- and post-education design with patients acting as their own controls. Parents were interviewed before and 1 yr after the programme. Most of the children were receiving inadequate medical care from their primary physicians, based mainly on bronchodilators. After the educational programme combined with a medical treatment based mainly on inhaled steroids, there was a decrease in emergency room visits and no need for hospital admissions. There was also a significant decrease in asthma severity and impairment scores (p<.0001). The combination of good medical care and an educational programme can reduce the symptoms of asthma and significantly increase the quality of life, as well as decreasing the costs of asthma treatment. We conclude that by applying the International Asthma Guidelines substantial success was achieved, resulting in moving the patients from crises-orientated management into a chronic care and preventive management mode.

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Undertreatment in a nonselected population of adult patients with asthma☆, ☆☆, ★, ★★

Cited by 94 publications

References 48 publications

The European Community Respiratory Health Survey: what are the main results so far?

The European Community Respiratory Health Survey: what are the main results so far?

Estudo comparativo entre o manejo da asma em uma unidade de referência da rede pública de Porto Alegre (RS) e as proposições do III Consenso Brasileiro no Manejo da Asma

Are International Asthma Guidelines effective for low-income Brazilian children with asthma?

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