The control of asthma in Italy. A multicentre descriptive study on young adults with doctor diagnosed current asthma

Background: Few data are available on the management of asthma in the general population. The aim of this study was to evaluate the level of asthma control in Italian patients, a decade after the publication of the international guidelines. Materials and methods: Within the framework of a multicentre, population-based study on people aged 20-44 years, 18 873 subjects replied to a postal screening questionnaire (response rate=72.7%) on the presence of asthma symptoms and exacerbations, and their impact on daily life. All subjects reporting having ever had a doctor diagnosis of asthma and either taking medicine for asthma when interviewed or having had an asthma attack in the last 12 months, were considered current asthmatics. Results: Of the screened subjects, 649 (3.4%) were current asthmatics. Of these, only 14% did not report exacerbations or had been symptom-free in the last 12 months. More than 20% of current asthmatics had their daily life activities seriously impaired and 54 patients (8%) had at least one hospital/emergency department admission as a result of asthma exacerbation in the last 12 months. The life impairment and the rates of hospitalization significantly increased as the control of the symptoms worsened. The use of asthma drugs was quite common in current asthmatics: 586 (90.2%) reported having been under pharmacological treatment in the last 12 months. Only 63 patients (10%) had the disease under control (neither symptoms nor life impairment): they had a significantly higher percentage of drug use (100% vs 89%) and of daily use prescriptions (50% vs 36%) than non/moderately controlled asthmatics. Poorly controlled asthmatics had a significantly higher percentage of women (63% vs 44%), of patients with the coexistence of chronic cough and phlegm (47% vs 30%) than moderately/well-controlled asthmatics. The comparison between our data and similar data collected in 1991 in Italy showed that the use of asthma drugs increased by about 12%, while the control of symptoms did not improve in the last decade. Conclustion: Despite the high percentage of drug users, the control of symptoms and exacerbations was overall poor in Italy and resulted in a heavy individual and social burden, pointing out that the guideline goals have far from been reached in Italy.