Elsevier

Respiratory Medicine

Volume 100, Issue 1, January 2006, Pages 140-147
Respiratory Medicine

Asthma-related resource use and cost by GINA classification of severity in three European countries

https://doi.org/10.1016/j.rmed.2005.03.041Get rights and content
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Summary

Background

This study assessed the relationship between asthma burden and asthma severity in France, Italy, and Spain.

Methods

Adult asthmatics, 18–55 years of age, completed a questionnaire while visiting a respiratory physician in 1998 and 1999. Asthma severity was categorized by physicians as intermittent, mild persistent, moderate persistent, or severe persistent according to Global Initiative for Asthma (GINA) guidelines.

Results

Totals of 282 patients in France, 500 in Italy, and 296 in Spain entered the study. There were few differences between the three countries in the asthma symptom burden. Most patients with persistent asthma had used inhaled corticosteroids in the previous 14 days. Unexpectedly, 35% (Italy) to 83% (Spain) of patients with intermittent asthma also had used inhaled corticosteroids. In Spain, visits to the emergency department were more frequent (OR 7.0, 95% CI 4.9–10.0 with Italy as reference) and the costs of emergency care in all asthma severity categories were up to 10 times higher than in Italy and France. The frequency of hospitalizations did not differ systematically between the three countries.

Conclusions

Inadequate control of asthma symptoms among patients with severe persistent asthma could not be entirely explained by under-prescribing of asthma medications. The use of inhaled corticosteroids by patients with intermittent asthma might reflect misclassification of asthma severity, possibly due to difficulty in interpreting the GINA guidelines. The relatively high cost of emergency care in Spain does not appear to be related to greater asthma severity or poorer symptom control, but may be a feature of the Spanish health care system.

Keywords

Asthma
Cost of illness
GINA guidelines
Severity
Specialist
Health care utilization
Europe

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