[Primary care asthma treatment: Are we following international consensus (GINA 2002)?]. / Tratamiento del asma en atención primaria: 'lo hacemos según el consenso internacional (GINA 2002)?

OBJECTIVE: To check whether treatment of asthma patients at our centre coincides with international criteria (GINA 2002). DESIGN: Transversal, descriptive study. SETTING: Urban primary care team. PARTICIPANTS: Asthma patients over 14 years old. MAIN MEASUREMENTS: Review of clinical histories (CH) and analysis of the last prescription between November 2002 and May 2003. RESULTS: We reviewed 436 CH, of which 395 made up the study group. 71.4% (SD, 66.9-75.8) were women. Average age was 51.4 (SD, 49.2-53.6). Classification of asthma as function of gravity was: intermittent (IA): 30% (25.7-34.3); light persistent (LPA): 24.8% (20.7-28.8); moderate persistent (MPA): 30.7% (26.4-35.1); serious persistent (SPA): 5.05% (3.19-7.54). Unclassified: 9.4% (6.83-12.5). Correct treatment: IA, 69.5% (61.6-77.4); LPA, 22.2% (14.4-30.1); MPA, 46.2% (7.8-54.7); SPA, 72.7% (49.8-89.3). The most common cause of incorrect treatment in all kinds of asthma was the use of international criteria (IC) at inadequate doses: IA, 47.5% (31.5-63.9); LPA, 73.8% (63.1-82.8); MPA, 38.9% (27.6-51.1); SPA, 33.3% (4.3-77.7). The scant use of B2CD.AD was noticeable: IA, 47.5% (31.5-63.9); LPA, 85.7% (76.4-92.4); MPA, 86.7% (74.3-92.1); SPA, 66.7% (22.3-95.7). The most commonly used active principles were salbutamol, salmeterol, budesonide, and montelukast. On overall measurement of good treatment, we found that 48.9% (n = 193) of patients had a correct prescription. CONCLUSIONS: In primary care, light forms of asthma are most commonly monitored. We found low concordance with the GINA 2002 directives. IC are widely used, but often at incorrect doses. We insist on the importance of classifying asthma according to its gravity in order to prescribe the right treatment.

Tratamiento del asma en atención primaria: ¿lo hacemos según el consenso internacional (GINA 2002)? / Primary care asthma treatment: are we following international consensus (GINA 2002)?

Objetivo. Comprobar si el tratamiento de los asmáticos de nuestro centro coincide con los criterios internacionales (GINA 2002). Diseño. Estudio descriptivo, transversal. Emplazamiento. Equipo de atención primaria urbano. Participantes. Asmáticos mayores de 14 años. Mediciones principales. Revisión de historias clínicas (HCAP) y análisis de la última prescripción entre noviembre de 2002 y mayo de 2003. Resultados. Se revisan 436 HCAP, de las que 395 constituyeron el grupo de estudio. El 71,4% (DE, 66,9-75,8) eran mujeres, con una edad media de 51,4 años (DE, 49,2-53,6). Clasificación del asma en función de la gravedad: intermitente (AI) 30%; persistente leve (APL) 24,8%; persistente moderada (APM) 30,7%; persistente grave (APG) 5,05%, no clasificado 9,4%. Tratamiento correcto: AI, 69,5%; APL, 22,2%; APM, 46,2%; APG, 72,7%. La causa más frecuente de tratamiento incorrecto en todos los tipos de asma es el uso de corticoides inhalados (CI) en dosis inadecuadas: AI, 47,5%; APL, 73,8%; APM, 38,9%; APG, 33,3%. Destaca el escaso uso de agonistas betaadrenérgicos de corta duración B2CD: AI, 47,5%; APL, 85,7%; APM, 86,7%; APG, 66,7%. Los principios activos más utilizados fueron: salbutamol, salmeterol, budesonida y montelukast. Como medida global de buen tratamiento, un 48,9% (n = 193) de pacientes tenía una adecuada prescripción. Conclusiones. Predominan las formas leves de asma controladas en atención primaria y se observa poca concordancia con las directrices GINA 2002. Los CI son ampliamente usados, pero destaca su incorrecta dosificación. Se considera muy importante clasificar el asma según su gravedad para prescribir el tratamiento adecuado

Objective. To check whether treatment of asthma patients at our centre coincides with international criteria (GINA 2002). Design. Transversal, descriptive study. Setting. Urban primary care team. Participants. Asthma patients over 14 years old. Main measurements. Review of clinical histories (CH) and analysis of the last prescription between November 2002 and May 2003. Results. We reviewed 436 CH, of which 395 made up the study group. 71.4% (SD, 66.9-75.8) were women. Average age was 51.4 (SD, 49.2-53.6). Classification of asthma as function of gravity was: intermittent (IA): 30% (25.7-34.3); light persistent (LPA): 24.8% (20.7-28.8); moderate persistent (MPA): 30.7% (26.4-35.1); serious persistent (SPA): 5.05% (3.19-7.54). Unclassified: 9.4% (6.83-12.5). Correct treatment: IA, 69.5% (61.6-77.4); LPA, 22.2% (14.4-30.1); MPA, 46.2% (7.8-54.7); SPA, 72.7% (49.8-89.3). The most common cause of incorrect treatment in all kinds of asthma was the use of international criteria (IC) at inadequate doses: IA, 47.5% (31.5-63.9); LPA, 73.8% (63.1-82.8); MPA, 38.9% (27.6-51.1); SPA, 33.3% (4.3-77.7). The scant use of B2CD.AD was noticeable: IA, 47.5% (31.5-63.9); LPA, 85.7% (76.4-92.4); MPA, 86.7% (74.3-92.1); SPA, 66.7% (22.3-95.7). The most commonly used active principles were salbutamol, salmeterol, budesonide, and montelukast. On overall measurement of good treatment, we found that 48.9% (n=193) of patients had a correct prescription. Conclusions. In primary care, light forms of asthma are most commonly monitored. We found low concordance with the GINA 2002 directives. IC are widely used, but often at incorrect doses. We insist on the importance of classifying asthma according to its gravity in order to prescribe the right treatment