Figures
- Fig. 1—
Definition of the study population. GP: general practitioner.
Tables
- Table 1—
Comparison of asthma control between groups
Group GP GP+SPE SPE Overall p-value 1. During the past 4 weeks, for how much of the time did your asthma prevent you from getting as much done as normal at work or at home? 0.000 a) None of the time 177 (38.7) 199 (30.5) 76 (53.1) 452 (36.1) b) A little of the time 126 (7.6) 130 (19.9) 31 (21.7) 287 (22.9) c) Some of the time 127 (27.8) 251 (38.4) 28 (19.6) 406 (32.4) d) Most of the time 22 (4.8) 53 (8.1) 6 (4.2) 81 (6.5) e) All of the time 5 (1.1) 20 (3.1) 2 (1.4) 27 (2.2) 2. During the past 4 weeks, how often have you had shortness of breath? 0.000 a) Not at all 79 (17.4) 111 (17.2) 50 (35.2) 240 (19.3) b) Once or twice a week 194 (42.7) 238 (36.9) 57 (40.1) 489 (39.4) c) 3–6 times a week 51 (11.2) 72 (11.2) 10 (7.0) 133 (10.7) d) Once a day 67 (14.8) 74 (11.5) 10 (7.0) 151 (12.2) e) More than once a day 63 (13.9) 150 (23.3) 15 (10.6) 228 (18.4) 3. During the past 4 weeks, how often did your asthma symptoms (wheezing, coughing, shortness of breath, chest tightness or pain) wake you up at night or earlier than usual in the morning? a) Not at all 163 (35.7) 214 (33.2) 89 (62.7) 466 (37.5) 0.000 b) Once or twice 138 (30.3) 194 (30.1) 28 (19.7) 360 (29.0) c) Once a week 61 (13.4) 75 (11.6) 11 (7.7) 147 (11.8) d) 2–3 nights a week 54 (11.8) 88 (13.6) 5 (3.5) 147 (11.8) e) ≥4 nights a week 40 (8.8) 74 (11.5) 9 (6.3) 123 (9.9) 4. During the past 4 weeks, how often have you used your rescue inhaler or nebulizer medication (such as salbuterol)? 0.000 a) Not at all 96 (21.1) 151 (23.6) 70 (50.0) 317 (25.7) b) Once a week or less 107 (23.5) 135 (21.1) 40 (28.6) 282 (22.9) c) A few times a week 105 (23.1) 150 (23.5) 17 (12.1) 272 (22.0) d) 1 or 2 times per day 94 (20.7) 120 (18.8) 7 (5.0) 221 (17.9) e) ≥3 times per day 53 (11.6) 83 (13.0) 6 (4.3) 142 (11.5) 5. How would you rate your asthma control during the past 4 weeks? 0.000 a) Completely controlled 102 (22.3) 135 (20.9) 58 (40.6) 295 (23.6) b) Well controlled 237 (51.7) 352 (54.4) 62 (43.4) 651 (52.2) c) Somewhat controlled 74 (16.2) 115 (17.8) 15 (10.5) 204 (16.3) d) Poorly controlled 24 (5.2) 29 (4.5) 7 (4.9) 60 (4.8) e) Not at all controlled 21 (4.6) 16 (2.5) 1 (0.7) 38 (3.0) Level of asthma control <0.0001 Correct 117 (26.4) 134 (21.5) 72 (52.2) 323 (26.8) Moderate 178 (40.2) 233 (37.5) 43 (31.2) 454 (37.7) Poor 148 (33.4) 255 (41.0) 23 (16.7) 426 (35.4) Data are presented as n (%) unless otherwise specified. GP: general practitioner; SPE: specialist. Correct asthma control: items c, d or e were never checked for any of the five questions; moderately uncontrolled asthma: items c, d or e were checked for one or two questions; poor asthma control: items c, d or e were checked for at least three questions.
- Table 2—
Comparison of patient characteristics
Group Overall p-value GP GP+SPE SPE Age mean±sd 35.3±9.5 36.9±10.0 34.7±10.0 36.1±9.9 0.003 Sex female 243 (52.9) 369 (56.7) 69 (48.3) 681 (54.3) 0.140 BMI 0.599 <20% 66 (15.4) 92 (15.5) 25 (19.4) 183 (15.9) 20–25% 228 (53.3) 293 (49.5) 69 (53.5) 590 (51.3) 25–30% 79 (18.5) 120 (20.3) 22 (17.1) 221 (19.2) >30% 55 (12.9) 87 (14.7) 13 (10.1) 155 (13.5) Smoking 0.000 Nonsmokers 267 (58.6) 472 (73.0) 120 (85.1) 859 (69.1) 1–9 cigarettes·day−1 79 (17.3) 84 (13.0) 11 (7.8) 174 (14.0) ≥10 cigarettes·day−1 110 (24.1) 91 (14.1) 10 (7.1) 211 (17.0) Peak-flow meter % of theoretical value 0.003 >80% 252 (58.6) 349 (57.8) 98 (75.4) 699 (60.1) 61–80% 103 (24.0) 152 (25.2) 23 (17.7) 278 (23.9) 31–60% 75 (17.4) 103 (17.1) 9 (6.9) 187 (16.1) Frequency of diurnal asthma 0.028 Once a week or less 299 (76.3) 396 (72.4) 104 (86.0) 799 (75.4) >once a week 52 (13.3) 92 (16.8) 9 (7.4) 153 (14.4) ≥once daily 41 (10.5) 59 (10.8) 8 (6.6) 108 (10.2) Frequency of nocturnal asthma attacks 0.000 Never 231 (56.1) 282 (50.4) 98 (78.4) 611 (55.7) >2 monthly 120 (29.1) 177 (31.7) 20 (16.0) 317 (28.9) >once a week 38 (9.2) 67 (12.0) 3 (2.4) 108 (9.9) Almost each night 23 (5.6) 33 (5.9) 4 (3.2) 60 (5.5) All data are presented as n (%) unless otherwise stated. GP: general practitioner; SPE: specialists; BMI: body mass index.
- Table 3—
Comparison of medical resource utilisation(other than medication) and proportion of patients with written action plans in case of asthma exacerbation
Group Overall p-value GP GP+SPE SPE Patients with written action plans in case of asthma crises 68 (16.2) 162 (27.3) 39 (30.0) 269 (23.6) 0.000 Average frequency of visits to GP 0.000 Once a year 34 (7.4) 45 (6.9) 79 (7.1) Twice a year 101 (22.0) 96 (14.7) 197 (17.7) Four times a year 214 (46.5) 270 (41.3) 484 (43.5) Every month 111 (24.1) 242 (37.1) 353 (31.7) Average frequency of visits to specialist 0.000 Once a year 385 (59.0) 24 (16.8) 409 (51.4) Twice a year 178 (27.3) 81 (56.6) 259 (32.5) Four times a year 76 (11.6) 34 (23.8) 110 (13.8) Every month 14 (2.1) 4 (2.8) 18 (2.3) Asthma-related hospital admissions during past 12 months 0.001 None 427 (94.1) 566 (86.8) 133 (93.0) 1126 (90.2) Once 20 (4.4) 55 (8.4) 8 (5.6) 83 (6.6) More than once 7 (1.5) 31 (4.8) 2 (1.4) 40 (3.2) All data are presented as n (%) unless otherwise stated. GP: general practitioner; SPE: specialist.
- Table 4—
Comparison of dispensed treatments#
Group Overall p-value GP GP+SPE SPE Antiasthma-controller therapy ICS 184 (42.0) 311 (49.8) 59 (43.1) 554 (46.2) 0.031 LABA 129 (29.5) 221 (35.4) 41 (29.9) 391 (32.6) 0.097 COMBO LABA-ICS 243 (55.5) 373 (59.8) 97 (70.8) 713 (59.5) 0.006 Oral xanthines 21 (4.8) 51 (8.2) 3 (2.2) 75 (6.3) 0.009 LTRA 90 (20.5) 204 (32.7) 46 (33.6) 340 (28.4) 0.000 Controller regimens 0.004 Isolated ICS 50 (11.4) 48 (7.7) 4 (2.9) 102 (8.5) ICS+LABA (separate medications) 60 (13.7) 85 (13.6) 20 (14.6) 165 (13.8) COMBO LABA-ICS 123 (28.1) 142 (22.8) 42 (30.7) 307 (25.6) COMBO ABA-ICS+ICS 22 (5.0) 33 (5.3) 11 (8.0) 66 (5.5) COMBO LABA-ICS+LTRA 43 (9.8) 81 (13.0) 23 (16.8) 147 (12.3) Others/none 140 (32.0) 235 (37.7) 37 (27.0) 412 (34.4) Antiasthma reliever medications SABA 323 (73.7) 454 (72.8) 79 (57.7) 856 (71.4) 0.001 Anticholinergic medication 4 (0.9) 13 (2.1) 0 (0.0) 17 (1.4) Anticholinergic medication +SABA 32 (7.3) 61 (9.8) 11 (8.0) 104 (8.7) 0.356 Other medications Oral corticosteroids 166 (37.9) 297 (47.6) 52 (38.0) 515 (43.0) 0.003 Antitussives 131 (29.9) 176 (28.2) 26 (19.0) 333 (27.8) 0.042 Expectorants 214 (48.9) 357 (57.2) 51 (37.2) 622 (51.9) 0.000 Antibiotics 254 (58.0) 397 (63.6) 60 (43.8) 711 (59.3) 0.000 Change of therapy during the past 12 months None 231 (50.2) 239 (36.6) 61 (42.7) 531 (42.3) 0.000 Addition of medication(s) 135 (29.3) 251 (38.4) 30 (21.0) 416 (33.1) 0.000 Suppression of medication(s) 56 (12.2) 120 (18.4) 17 (11.9) 193 (15.4) 0.009 Any increase of dosage 36 (7.8) 95 (14.5) 16 (11.2) 147 (11.7) 0.003 Any decrease of dosage 22 (4.8) 51 (7.8) 27 (18.9) 100 (8.0) 0.000 Total change of therapy 34 (7.4) 53 (8.1) 12 (8.4) 99 (7.9) 0.881 Data are presented as n (%), n = 1,199. #: Presence of medication category in the computerised dispensing record. ICS: inhaled corticosteroids; LABA: long-acting beta agonists; COMBO: combination; LTRA: leucotriene receptor antagonists. SABA: short-acting beta agonists; GP: general practitioner; SPE: specialist.
- Table 5—
Asthma perception and the need for additional information regarding asthma
Group Overall p-value GP GP+SPE SPE Feels enough informed regarding asthma 327 (71.7) 481 (74.9) 120 (84.5) 928 (74.8) 0.009 Feels enough informed regarding antiasthma treatment 329 (76.9) 448 (77.1) 102 (76.7) 879 (77.0) 0.993 Patients searched spontaneously for information regarding asthma 167 (37.3) 353 (55.8) 65 (46.1) 585 (47.9) 0.000 Asthma considered as a major concern or a handicap 169 (38.1) 293 (47.2) 35 (25.2) 497 (41.3) 0.000 Data are presented as n (%). GP: general practitioner; SPE: specialist.
Vol 27 Issue 1
Table of Contents
Management of asthma in patients supervised by primary care physicians or by specialists
