Change in asthma and COPD prescribing by Italian general practitioners between 2006 and 2008.

AIMS To explore the trend in prescribing of drugs classified within the R03 therapeutic pharmacological subgroup (drugs for obstructive airway diseases) of the Anatomical Therapeutic Chemical (ATC) classification. METHODS Comparison of GP-collected data on physician-patient contacts and drug prescriptions for asthma and COPD in 2006 and 2008. RESULTS Compared to 2006, in 2008 patients with COPD were prescribed more long-acting bronchodilators; use of tiotropium increased, whilst use of long-acting β2-agonists (LABAs) and short-acting antimuscarinic agents decreased. However, 55.9% of patients in 2006, and 47.8% in 2008, received an inhaled corticosteroid (ICS), mainly as a LABA/ICS fixed combination inhaler. Compared to 2006, in 2008 there were increased prescriptions of LABA/ICS fixed combination inhalers for asthma, but only 54.5% of all prescriptions included an ICS. This could explain the large use of short-acting β2-agonists, a marker of poor asthma control. Remarkably, LABA/ICS fixed combination inhalers were prescribed more frequently in COPD than in asthma. CONCLUSIONS Our data indicate that adherence to guidelines is still low. Patients with asthma and COPD are undertreated by Italian GPs, with a trend to a change in COPD prescribing likely driven by new scientific information.

[1]  I. Adcock,et al.  Degree of control of physician-diagnosed asthma and COPD in Italy. , 2016, Monaldi archives for chest disease = Archivio Monaldi per le malattie del torace.

[2]  José Miguel Rodríguez-González-Moro,et al.  Misdiagnosis of patients receiving inhaled therapies in primary care , 2010, International journal of chronic obstructive pulmonary disease.

[3]  M. Cazzola,et al.  Current opinion: Pharmacological approaches in asthma and COPD , 2009, Breathe.

[4]  G. Westert,et al.  Why don't physicians adhere to guideline recommendations in practice? An analysis of barriers among Dutch general practitioners , 2009, Implementation Science : IS.

[5]  M. Cazzola,et al.  Primary care of the patient with chronic obstructive pulmonary disease in Italy. , 2009, Respiratory medicine.

[6]  M. Decramer,et al.  A 4-year trial of tiotropium in chronic obstructive pulmonary disease. , 2008, The New England journal of medicine.

[7]  Rupert Jones,et al.  Accuracy of diagnostic registers and management of chronic obstructive pulmonary disease: the Devon primary care audit , 2008, Respiratory research.

[8]  G. Liistro,et al.  Diagnostic certainty, co-morbidity and medication in a primary care population with presumed airway obstruction: the DIDASCO2 study. , 2008, Primary care respiratory journal : journal of the General Practice Airways Group.

[9]  C. P. Schayck,et al.  Overtreatment with inhaled corticosteroids and diagnostic problems in primary care patients, an exploratory study. , 2008, Family practice.

[10]  P. J. Barnes,et al.  Global strategy for asthma management and prevention: GINA executive summary , 2008, European Respiratory Journal.

[11]  Bartolome Celli,et al.  Salmeterol and fluticasone propionate and survival in chronic obstructive pulmonary disease. , 2007, The New England journal of medicine.

[12]  D. Price,et al.  Misdiagnosis of COPD and Asthma in Primary Care Patients 40 Years of Age and Over , 2006, The Journal of asthma : official journal of the Association for the Care of Asthma.

[13]  W. MacNee,et al.  Standards for the diagnosis and treatment of patients with COPD: a summary of the ATS/ERS position paper , 2004, European Respiratory Journal.

[14]  I. Rubinstein,et al.  Long-term montelukast therapy in moderate to severe COPD--a preliminary observation. , 2004, Respiratory medicine.

[15]  F. Auxilia,et al.  Analysis of some variables concerning guidelines adopted in a hospital in Milan: quantity, quality and physicians' attitude; which is the reciprocal influence of these factors? , 2003, European journal of public health.

[16]  N. Chavannes,et al.  Detection of asthma and chronic obstructive pulmonary disease in primary care , 2003, European Respiratory Journal.

[17]  A. Buist,et al.  Similarities and differences between asthma and chronic obstructive pulmonary disease: treatment and early outcomes , 2003, European Respiratory Journal.

[18]  M. Decramer,et al.  Impact of COPD in North America and Europe in 2000: subjects' perspective of Confronting COPD International Survey , 2002, European Respiratory Journal.

[19]  Brigit VanGraafeiland,et al.  National Asthma Education and Prevention Program. , 2002, The Nurse practitioner.

[20]  A Liberati,et al.  Practice guidelines: useful and "participative" method? Survey of Italian physicians by professional setting. , 2001, Archives of internal medicine.

[21]  F. V. D. Heijden,et al.  Underdiagnosis of asthma: is the doctor or the patient to blame? The DIMCA project , 2000, Thorax.

[22]  Third Expert Panel on theDiagnosis,et al.  Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma , 1997 .

[23]  Partridge Mr.  Delivering optimal care to the person with asthma: what are the key components and what do we mean by patient education? , 1995 .

[24]  M. Beauchesne,et al.  Effect of theophylline on the rate of moderate to severe exacerbations among patients with chronic obstructive pulmonary disease. , 2008, British journal of clinical pharmacology.

[25]  T. Seemungal,et al.  The prevention of chronic obstructive pulmonary disease exacerbations by salmeterol/fluticasone propionate or tiotropium bromide. , 2008, American journal of respiratory and critical care medicine.

[26]  G. Viegi,et al.  Respiratory symptoms/diseases, impaired lung function, and drug use in two Italian general population samples. , 2008, Respiratory medicine.

[27]  F. Martinez,et al.  Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. , 2007, American journal of respiratory and critical care medicine.

[28]  F. Maltais,et al.  Tiotropium in Combination with Placebo, Salmeterol, or Fluticasone–Salmeterol for Treatment of Chronic Obstructive Pulmonary Disease A Randomized Trial , 2007 .

[29]  Expert Panel Report 3 (EPR-3): Guidelines for the Diagnosis and Management of Asthma-Summary Report 2007. , 2007, The Journal of allergy and clinical immunology.

[30]  P. Dorinsky,et al.  The Salmeterol Multicenter Asthma Research Trial: a comparison of usual pharmacotherapy for asthma or usual pharmacotherapy plus salmeterol. , 2006, Chest.

[31]  O. Skjønsberg,et al.  How representative are clinical study patients with asthma or COPD for a larger "real life" population of patients with obstructive lung disease? , 2005, Respiratory medicine.

[32]  J. Bourbeau,et al.  Inhaled corticosteroids in COPD: determinants of use and trends in patient persistence with treatment. , 2004, Canadian respiratory journal.

[33]  M. Stulbarg,et al.  OBSTRUCTIVE PULMONARY DISEASE: The Clinician's Perspective , 1998 .

[34]  M. Partridge.  Delivering optimal care to the person with asthma: what are the key components and what do we mean by patient education? , 1995, The European respiratory journal.