[Survey on changes in asthma treatment and management]

A total of 518 chest physicians selected at random from a national list participated in a survey on asthma management. This paper dealt with queries about diagnostic procedures, methods for recognizing life-threatening asthma attacks, patient education and treatment for acute asthma in adults and in children older than 6 years. A total of 198 replies were received (38.2% of questionnaires mailed). A mean score of frequency of use (from 0 = never to 3 = always) was used for assessing the responses. Results were compared with a similar survey performed in 1994, disclosing a satisfactory trend in diagnostic tests with the bronchodilator test and in oral steroid courses (2.74 +/- 2.3 vs 2.30 +/- 1.05 and 1.26 +/- 0.96 vs 0.98 +/- 0.84, respectively). Skin tests were less used (0.50 +/- 0.83 vs 0.88 +/- 1.08). Results reporting how to assess the severity of asthma attacks, such as taking into account symptoms or drop in PEFR, were more frequent in the present study (2.65 +/- 0.66 vs 2.29 +/- 0.90 and 1.93 +/- 1.05 vs 1.51 +/- 1.20, respectively). PEFR or spirometry used by the physician for assessing severity of asthma attacks was not always performed and its comparison was no better than in 1994 (2.14 +/- 1.04 vs 2.13 +/- 0.70). Data regarding patient information and education ranked equal or better than in the 1994 survey. For the treatment of acute severe episodes, almost all responders in the present study chose inhaled 12 agonists (IBA) for adults and children, thus improving with respect to the previous study (first option 85.3 vs 57.5% and 81.0 vs 63.4%, respectively). For maintenance therapy, a good trend was also observed with more responders who now chose inhaled steroid (IS) as a first choice formulation, specially in children (2.09 +/- 1.01 vs 1.61 +/- 1.00). The average normal and maximal daily doses of IS for adults and children were higher than in 1994 and were now in agreement with recommended doses. The recommendation of short acting IBA for treating and preventing symptoms was noticeably less frequent in the present study either for adults or for children (0.40 +/- 0.78 vs 1.23 +/- 1.10 and 0.21 +/- 0.58 vs 1.23 +/- 1.00, respectively). Hyposensitization was less recommended than in 1994. Despite a tendency to improve treatment and management, considerable differences with asthma guidelines still remain.