A multinational study of treatment failures in asthma management
Authors: Burney, P.1; Potts, J.1; Aït-Khaled, N.2; Sepulveda, R.M.D.3; Zidouni, N.4; Benali, R.5; Jerray, M.6; Musa, O.A.A.7; El-Sony, A.7; Behbehani, N.8; El-Sharif, N.9; Mohammad, Y.10; Khouri, A.11; Paralija, B.12; Eiser, N.13; Fitzgerald, M.14; Abu-Laban, R.15
Source: The International Journal of Tuberculosis and Lung Disease, Volume 12, Number 1, January 2008 , pp. 13-18(6)
Publisher: International Union Against Tuberculosis and Lung Disease
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Abstract:
SETTING: Emergency rooms.OBJECTIVE: To assess quality of care and its determinants for asthma patients before emergency room treatment.DESIGN: Consecutive patients with acute severe asthma attending emergency rooms were questioned about the severity of their disease and treatment in the previous 4 weeks. Prescriptions of inhaled corticosteroids were recorded. Other outcomes included self-reported adherence to treatment and loss of work.RESULTS: Thirteen centres in 11 countries recruited 1156 patients. Only 36% of patients with persistent asthma had been prescribed an adequate dose of inhaled corticosteroids. This percentage improved in those receiving regular care from the same doctor (OR 2.86, 95%CI 1.38-5.96), and was at least as good for the 10% of patients receiving `private' health care (OR 3.08, 95%CI 1.69-5.62). Forty-four per cent of patients had health insurance covering some asthma medications. These patients were more likely to be receiving adequate inhaled corticosteroids (OR 1.74, 95%CI 1.17-2.58), and reported better adherence than those without insurance (OR 3.00, 95%CI 1.64-5.50). Of those on adequate inhaled corticosteroids, 18% had lost work in each of the 4 previous weeks compared with 59% among those more than one treatment step below the recommended dose.CONCLUSIONS: Access to adequate treatment is critical for better management of asthma.Keywords: asthma; emergency room; delivery of care; cost of illness; inhaled corticosteroids
Document Type: Regular paper
Affiliations: 1: Department of Respiratory Epidemiology and Public Health, National Heart and Lung Institute, Imperial College, London, UK 2: International Union Against Tuberculosis and Lung Disease, Paris, France 3: University of Chile School of Medicine, National Thoracic Institute, Adult Respiratory Programme, Ministry of Public Health, Santiago, Chile 4: Service de Pneumo-phtisiologie, Centre Hospitalo-Universitaire de Béni-Messous et Faculté de Médecine d'Alger, Algiers, Algeria 5: Université Badji Mokhtar, Faculté de Médecine, Annaba, Algeria 6: Service de Pneumo-allergologie, Hôpital Universitaire F Hached, Sousse, Tunisia 7: Epilab, Khartoum, Sudan 8: Department of Medicine, Kuwait University, Kuwait City, Kuwait 9: Faculty of Public Health, Alquds University, Jerusalem, Palestine 10: Department of Internal Medicine, Université Tishreen, Lattakia, Syria 11: Aleppo University Hospital, Aleppo, Syria 12: Clinic of Lung Disease and Tuberculosis, Clinical Centre of University Sarajevo, Sarajevo, Bosnia and Herzegovina 13: Chest Clinic, University Hospital Lewisham, London, UK 14: University of British Columbia Respiratory Clinic, Vancouver, BC, Canada 15: Department of Emergency Medicine, Vancouver General Hospital, Vancouver, BC, Canada
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