A multinational study of treatment failures in asthma management

Int J Tuberc Lung Dis. 2008 Jan;12(1):13-8.


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.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Absenteeism
  • Acute Disease
  • Administration, Inhalation
  • Adolescent
  • Adrenal Cortex Hormones / administration & dosage*
  • Adult
  • Aged
  • Aged, 80 and over
  • Anti-Asthmatic Agents / administration & dosage*
  • Asthma / drug therapy*
  • Asthma / epidemiology
  • Commission on Professional and Hospital Activities / statistics & numerical data
  • Emergency Service, Hospital / statistics & numerical data*
  • Female
  • Health Services Accessibility / statistics & numerical data*
  • Humans
  • Insurance, Health / statistics & numerical data
  • Male
  • Middle Aged
  • National Health Programs / statistics & numerical data
  • Outcome and Process Assessment, Health Care / statistics & numerical data*
  • Patient Compliance / statistics & numerical data
  • Severity of Illness Index
  • Treatment Failure


  • Adrenal Cortex Hormones
  • Anti-Asthmatic Agents