Health care education, delivery, and quality
Asthma control in Europe: A real-world evaluation based on an international population-based study

https://doi.org/10.1016/j.jaci.2007.09.019Get rights and content

Background

Epidemiologic evidence related to asthma control in patients from the general population is scanty.

Objectives

We sought to assess asthma control in several European centers according to the Global Initiative for Asthma (GINA) guidelines and to investigate its determinants.

Methods

In the European Community Respiratory Health Survey II (1999-2002), 1241 adults with asthma were identified and classified into inhaled corticosteroid (ICS) users and non-ICS users in the last year. Control was assessed in both groups by using the GINA proposal (controlled, partly controlled, and uncontrolled asthma), and it was related to potential determinants.

Results

Only 15% (95% CI, 12% to 19%) of subjects who had used ICSs in the last year and 45% (95% CI, 41% to 50%) of non-ICS users had their asthma under control; individuals with uncontrolled asthma accounted for 49% (95% CI, 44% to 53%) and 18% (95% CI, 15% to 21%), respectively. Among ICS users, the prevalence of uncontrolled asthma showed great variability across Europe, ranging from 20% (95% CI, 7% to 41%; Iceland) to 67% (95% CI, 35% to 90%; Italy). Overweight status, chronic cough and phlegm, and sensitization to Cladosporium species were associated with poor control in ICS users. About 65% and 87% of ICS users with uncontrolled and partly controlled asthma, respectively, were on a medication regimen that was less than recommended by the GINA guidelines.

Conclusion

Six of 7 European asthmatic adults using ICSs in the last year did not achieve good disease control. The large majority of subjects with poorly controlled asthma were using antiasthma drugs in a suboptimal way. A wide variability in asthma control emerged across Europe.

Clinical implications

Greater attention should be paid to asthma management and to the implementation of the GINA guidelines.

Section snippets

Study design

The ECRHS8 is a multicenter study on the prevalence, determinants, and management of asthma performed in 48 centers during 1991 through 1993. The design of the survey involved 2 stages. In the first stage a screening questionnaire on respiratory symptoms was mailed to a community-based probability sample of 20- to 44-year-old persons. In the second stage a 20% random sample of responders to stage 1, with the addition of subjects who reported symptoms of waking with shortness of breath or asthma

Participants and nonparticipants

Of the 15,705 subjects participating in the ECRHS I from 25 centers, 9580 took part in the ECRHS II (response rate, 61%). Participants were slightly older than nonparticipants (median, 34 [interquartile range, 7] years vs 33 [interquartile range, 7] years; P < .001), and the proportion of subjects who reported that they were smokers in the ECRHS I was significantly smaller in subjects participating in the ECRHS II with respect to subjects not participating (36% vs 44%, P < .001).

Asthmatic sample

In the ECRHS II

Discussion

Our study showed that 85% of the European asthmatic adults from the ECRHS II who had used ICSs in the last 12 months were not able to achieve total control of the disease: 49% of them had uncontrolled asthma, and 36% had partly controlled asthma. Among those who had not used ICSs in the last 12 months, 18% had uncontrolled and 36% had partly controlled asthma. These results confirm the evidence that asthma control is suboptimal in a remarkable proportion of patients, according to previous

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  • National Heart Lung and Blood Institute

    Global Initiative for Asthma. Global strategy for asthma management and prevention. NHLBI/WHO workshop report

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    The coordination of the European Community Respiratory Health Survey II was supported by the European Commission as part of their Quality of Life program.

    Disclosure of potential conflict of interest: The authors have declared that they have no conflict of interest.

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