Prescriptive adherence to GINA guidelines and asthma control: An Italian cross sectional study in general practice - 21/01/19

Doi : 10.1016/j.rmed.2018.11.001

Sandra Baldacci ^a,^⁎, Marzia Simoni ^a, Sara Maio ^a, Anna Angino ^a, Franca Martini ^a, Giuseppe Sarno ^a, Sonia Cerrai ^a, Patrizia Silvi ^a, Anna Paola Pala ^b, Megon Bresciani ^a, Pierluigi Paggiaro ^c, Giovanni Viegi ^a,^d
ARGA Collaborative Group
Anna Angino ^e , Sandra Baldacci ^e , Megon Bresciani ^e , Sonia Cerrai ^e , Francesco Di Pede ^e , Sara Maio ^e , Franca Martini ^e , Bona Barbara Piegaia ^e , Giuseppe Sarno ^e , Patrizia Silvi ^e , Giovanni Viegi ^e,^h , Maurizio Mangione ^f , Anna Paola Pala ^f , Elena Bacci ^g , Laura Carrozzi ^g , Federico Dente ^g , Pierluigi Paggiaro ^g , Francesco Pistelli ^g , Lorenza Bancalari ⁱ , Maria Pia Foschino ^j , Andrea Pelucchi ^k , Gianna Moscato ^l , Pasquale Pierimarchi ^m , Barbara Brunetto ⁿ , Patrizia Iacovacci ⁿ , Carlo Pini ⁿ , Raffaella Tinghino ⁿ , Francesco Forastiere ^o , Carlo Alberto Perucci ^o , Daniela Porta ^o , Laura Ancona ^o, Sara Protasi ^o, Barbara Lazazzera ^o, Valentina Ziroli ^o, Eleonora D'Armini ^o, Sabella Festa Campanile ^o, Monica Ferri ^o, Paola Lorusso ^o, Riccardo Pistelli ^p , Rita Salotti ^q , Marco Santagati ^q , Elisabetta Agea ^r , Chiara Casciari ^r , Nicola Murgia ^r , Fabrizio Spinozzi ^r , Floriano Bonifazi ^s , Leonardo Antonicelli ^s , Maria Chiara Braschi ^s , Valeria Conti ^t , Amelia Filippelli ^t , Grazia Maria Corbi ^t , Giusy Russomanno ^t , Fulvio Braido ^u , Walter Canonica ^u , Francesco Balbi ^u , Isa Cerveri ^v , Angelo Corsico ^v , Amelia Grosso ^v
^e Pulmonary Environmental Epidemiology Unit, CNR Institute of Clinical Physiology, Via Trieste no. 41, 56126, Pisa, Italy
^f Technoscience Unit, CNR Institute of Clinical Physiology, Via G. Moruzzi no. 1, 56124, Pisa, Italy
^g Department of Surgery, Medicine, Molecular Biology and Critical Care, University of Pisa, Via Paradisa no. 2, 56124, Pisa, Italy
^h CNR Institute of Biomedicine and Molecular Immunology “A. Monroy”, Via U. La Malfa no. 153, 90146, Palermo, Italy
ⁱ Pneumology Unit, La Spezia Hospital, Italy
^j Respiratory Diseases Clinic, University of Foggia, Italy
^k Respiratory Physiopathology Unit, Sesto San Giovanni (MI), Italy
^l Maugeri Foundation, Pavia, Italy
^m CNR Neurobiology and Molecular Medicine, Rome, Italy
ⁿ National Health Institute, Rome, Italy
^o Epidemiology Dept, Regional Health Service, Latium, Rome, Italy
^p Gemelli Hospital, University Cattolica del Sacro Cuore, Rome, Italy
^q Italian Society of Hospital Pharmacy and Pharmaceutical Services of Health Companies, Italy
^r Internal Medicine and Oncologic Sciences, Dept. of Clinical and Experimental Medicine, Univ. of Perugia, Italy
^s Allergology Unit, University-Hospital, Ancona, Italy
^t Farmacology Unit, Dept. of Experimental Medicine, II University of Naples, Italy
^u Tisiologic and Pneumological Clinic, Dept. of Internal Medicine and Medical Specialties, University of Genoa, Italy
^v Department of Hematology, Pneumology, Cardiovascular Medical and Surgical Sciences, University of Pavia, Italy

^a Pulmonary Environmental Epidemiology Unit, CNR Institute of Clinical Physiology, Via Trieste no. 41, 56126, Pisa, Italy
^b Technoscience Unit, CNR Institute of Clinical Physiology, Via G. Moruzzi no. 1, 56124, Pisa, Italy
^c Department of Surgery, Medicine, Molecular Biology and Critical Care, University of Pisa, Via Paradisa no. 2, 56124, Pisa, Italy
^d CNR Institute of Biomedicine and Molecular Immunology “A. Monroy”, Via U. La Malfa no. 153, 90146, Palermo, Italy

^∗Corresponding author.

Abstract

Background

Although general practitioners (GPs) are frequently the first healthcare professionals whom asthma patients refer to for their symptoms, few studies have explored the extent of adherence to guidelines for asthma management based on data provided directly by GPs.

Aims of the present study were to assess drug prescriptions for asthma by GPs and to evaluate prescriptive adherence to GINA guidelines (GL) and its relationship with disease control in real life.

Methods

995 asthmatic patients (45% males, mean age 43.3 ± 17.7 yrs) were enrolled by 107 Italian GPs distributed throughout the country. Data on diagnosis, disease severity, prescribed anti-asthmatic drugs and control were collected through questionnaires filled out by GPs taking into consideration the 2009 GINA Guidelines. Data on drug use and chronic sinusitis, nasal polyposis, chronic bronchitis, emphysema were reported by patients through a self-administered questionnaire.

Results

The large majority of patients were classified by GPs as having intermittent (48.4%) or mild persistent asthma (25.3%); 61% had co-morbid allergic rhinitis (AR). The prevalent therapeutic regimen used by patients was a combination of inhaled corticosteroids (ICS) plus long-acting β₂-agonists (LABA) (54.1%), even in the intermittent/mild persistent group. ICS as mono-therapy or in combination with other drugs but LABA, was the second most frequently adopted treatment (14.4%). In general, the GPs adherence to GL treatment indications was 28.8%, with a significant association with a good asthma control (OR 1.85, 95% CI 1.18–2.92). On the other hand, comorbidity (OR 0.52, 95% CI 0.32–0.84), moderate (0.44, 0.28–0.69) and severe (0.06, 0.02–0.20) persistent asthma showed significant negative effects on asthma control.

Conclusions

Our results show that over-treatment of intermittent/mild persistent asthma is frequent in the GPs setting while therapeutic regimens are more appropriately applied for moderate/severe asthma. In general, we found low adherence to GINA GL treatment recommendations even if its relevance in asthma control was confirmed.

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Keywords : Cross sectional study, Asthma, Allergic rhinitis, Drug prescriptions, Adherence, GINA guidelines, Control