Prescriptive adherence to GINA guidelines and asthma control: An Italian cross sectional study in general practice

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

are italian pulmonologists aware of the guidelines for asthma management and do they know how to apply them

Background. Since 1995 GINA (Global Initiative on Asthma) guidelines for asthma management have been updated annually and published in order to promote better management of asthma in real life situations. The aim of our study was to assess the level of implementation of GINA Guidelines among Italian Pulmonary Specialists (PSs). Methods. A detailed questionnaire was sent to 296 Respiratory Units (RUs) in Italy in order to collect information about personnel involved in the management of asthma patients, availability and use of diagnostic tools, recommended treatment according to the degree of asthma severity, educational activity. Data were analysed by using the SPSS programme. Results. 74 (25%) questionnaires were returned and analysed. Most RUs (70%) do not have a dedicated asthma clinic; however, spirometry is available in more than 90% of RUs, although it is performed in no more than 50% of patients in most RUs. Asthma treatment concurs with GINA recommendations in most RUs. Educational activity is performed by almost all RUs, usually in informal manner, during clinical visits, whereas only few RUs arrange individual educational sessions or "asthma school". Conclusions. GINA guidelines for asthma management are applied by most Italian RUs included in this study in regard to educational activity and, to a lesser extent, to treatment. Surprisingly, many RUs perform spirometry in a relatively small number of patients despite its availability

Knowledge and health care resource allocation: CME/CPD course guidelines-based efficacy.

BACKGROUND: Most health care systems consider continuing medical education a potential tool to improve quality of care and reduce disease management costs. Its efficacy in general practitioners needs to be further explored. OBJECTIVE: This study assesses the effectiveness of a one-year continuing medical education/continuing professional development course for general practitioners, regarding the improvement in knowledge of ARIA and GINA guidelines and compliance with them in asthma management. METHODS: Sixty general practitioners, covering 68,146 inhabitants, were randomly allocated to continuing medical education/continuing professional development (five residential events +four short distance-learning refresher courses over one year) or no training. Participants completed a questionnaire after each continuing medical education event; key questions were repeated at least twice. The Local Health Unit prescription database was used to verify prescription habits (diagnostic investigations and pharmacological therapy) and hospitalizations over one year before and after training. RESULTS: Fourteen general practitioners (46.7%) reached the cut-off of 50% attendance of the training courses. Knowledge improved significantly after training (p < 0.001, correct answers to key questions +13%). Training resulted in pharmaceutical cost containment (trained general practitioners +0.5% vs. controls +18.8%) and greater attention to diagnosis and monitoring (increase in spirometry +63.4%, p < 0.01). CONCLUSION: This study revealed an encouraging impact of educational events on improvement in general practitioner knowledge of guidelines and daily practice behavioral changes. Long-term studies of large populations are required to assess the effectiveness of education on the behavior of physicians in asthma management, and to establish the best format for educational events

Annotated record of the detailed examination of Mn deposits from U.S.N.S. Kane 1968 expedition in the Northern Atlantic ocean

Five of 34 dredge hauls taken in the Atlantic Ocean recovered a material tentatively described on shipboard as a salmon-colored clay. X-ray diffraction analysis showed the clay material to consist principally of palygorskite. Occurring with the palygorskite are quartz, calcite, and dolomite. It is suggested that the palygorskite (and sepiolite) is the result of chemical precipitation brought about by the reaction of hydrothermal solutions with sea water

Il diagramma proporzionale di Venn delle malattie ostruttive del polmone nella popolazione generale italiana

Obiettivi dello studio: Il diagramma di Venn delle malattie ostruttive del polmone è stato recentemente quantificato. Abbiamo puntato a quantificare la proporzione della popolazione generale affetta da malattie croniche ostruttive del polmone e le combinazioni di asma, bronchite cronica (BC) ed enfisema, diagnosticate dal medico in due campioni di popolazione generale italiana, in rapporto all’ostruzione del flusso aereo (OA) determinata con la spirometria. Disegno di studio e partecipanti: Abbiamo analizzato i dati derivanti da due studi prospettici (4353 pazienti) condotti nell’area rurale del Delta del Po dal 1988 al 1991 e nell’area urbana di Pisa dal 1991 al 1993. Risultati: Le prevalenze di asma, BC ed enfisema sono state 5,3, 1,5 e 1,2% nel Delta del Po, e 6,5, 2,5 e 3,6% a Pisa. Un doppio diagramma di Venn, usato per quantificare la distribuzione di BC, enfisema ed asma, in relazione alla presenza/assenza di OA, ha identificato 15 categorie. OA isolata è stata la categoria più frequente (11,0% nel Delta del Po e 6,7% a Pisa), seguita da asma sola senza OA (3,3 e 4,3%, rispettivamente). La combinazione delle tre condizioni OLD è stata la sola categoria che ha sempre mostrato prevalenze più elevate per quelli con OA (0,20% nel Delta del Po e 0,16% a Pisa) piuttosto che per quelli senza (0,04 e 0,05%). Tra coloro con OLD od OA, il 61,4% nel Delta del Po ed il 38,2% a Pisa avevano OA isolata, il 24,8% ed il 41,9% OLD senza OA, ed il 13,8% ed il 19,9% presenza simultanea di OLD ed OA. In ambedue i sessi la frequenza di asma da sola diminuiva con l’età, mentre quella di OA isolata, BC-enfisema e la combinazione di asma e BC-enfisema aumentava. Conclusioni: Circa il 18% dei campioni della popolazione generale italiana ha riportato OLD o ha mostrato segni spirometrici di OA. I nostri dati confermano che il diagramma di Venn delle OLD può essere quantificato nella popolazione generale estendendo le categorie di malattie mutuamente esclusive (includendo diagnosi concomitanti di asma, bronchite cronica o enfisema) a 15

Indoor exposures and acute respiratory effects in two general population samples from a rural and an urban area in Italy

A study of indoor air exposures and acute respiratory effects in adults was conducted in the Po Delta (rural) and Pisa (urban) areas of Italy. Indoor exposures were monitored for nitrogen dioxide (NO2) and particulate matter &lt;2.5 μm (PM2.5) for 1 week during the winter or summer in a total of 421 houses (2/3 in Pisa). Information on house characteristics, subjects' daily activity pattern and presence of acute respiratory symptoms was collected by a standardized questionnaire. Peak expiratory flow (PEF) maneuvers were performed by adult subjects four times daily; maximum amplitude and diurnal variation were taken into account. Indices of NO2 and PM 2.5 exposures were computed as the product of weekly mean pollutant concentration by the time of daily exposure. Mean levels of pollutants were significantly higher in winter than in summer, regardless of the area. The relationship between exposure indices and acute respiratory symptoms was investigated only in winter. In spite of a slightly lower indoor level in the urban than in the rural area in winter (NO2: 15 vs. 22 ppb; PM 2.5: 67 vs. 76 μg/m3), prevalence rates of acute respiratory symptoms were significantly higher in the urban than in the rural area. Acute respiratory illnesses with fever were significantly associated with indices of NO2 (odds ratio (OR)= 1.66; 95% CI = 1.08-2.57) and PM2.5 exposures (OR = 1.62; 95% CI = 1.04-2.51), while bronchitic/asthmatic symptoms were associated only with PM2.5 (OR=1.39; 95% CI = 1.17-1.66). PEF variability was positively related only to PM2.5 exposure index (OR = 1.38; 95% CI = 1.24-1.54, for maximum amplitude; OR = 1.37; 95% CI = 1.23-1.53, for diurnal variation). In conclusion, indoor pollution exposures were associated with the presence of acute respiratory symptoms and mild lung function impairment in a rural and an urban area of Northern-Central Italy

Family history for chronic lung diseases and epidemiological determinants of COPD in three European countries

In order to investigate the effect of family history of lung diseases on chronic obstructive pulmonary disease (COPD), the authors analysed pooled data from England, the Netherlands and Italy in the framework of Concerted Action on COPD (BIOMED1). A total of 3,596 subjects (aged &gt;35 yrs) were studied; information on respiratory symptoms and reported family history of chronic bronchitis, asthma and allergic disorders was collected by standardized questionnaires; bronchial hyperreactivity (BHR), immunoglobulin (Ig)E level, and skin reactivity (SR) were determined in each study with comparable methods. Multiple logistic regression models were used for statistical analyses. Family history of asthma was associated with symptoms, in particular asthma attacks, BHR, IgE level and SR; risks increased when considering asthma in the first degree of relatives. Family history of allergic disorders was associated with hay fever and with SR. Family history of chronic bronchitis was associated with symptoms, in particular cough/phlegm, but no effect was observed on BHR, IgE and SR. These results were evident in both never- and ever-smokers. However, the impairment of lung function (forced expiratory volume in one second (FEV1) expressed as a percentage of the predicted value) was found only in smokers with a family history of chronic bronchitis. Family history of asthma did not significantly affect pulmonary function and that of allergic disorders was associated with higher FEV1% values. In asymptomatic subjects, the association between the presence of family history of asthma and BHR, IgE, and of family history of allergy with SR were still present. In conclusion, a familiarity for different chronic respiratory conditions was associated with specific epidemiological determinants of chronic obstructive pulmonary disease, asthma and allergic disorders. Family history of chronic bronchitis significantly affected lung function only in ever-smoker subjects