Guidelines application for asthma and rhinitis management: ARGA (Respiratory allergic diseases: monitoring study of GINA and ARIA guidelines) project

Background: in Italy, a big effort has been made to disseminate GINA and ARIA GuideLines (GL) for asthma and rhinitis management within the setting of specialist and general practice. Despite a general good knowledge of GL, their implementation within the clinical practice seems still poor.

Objective: to assess the level of application of GL for asthma and rhinitis management within general practitioners (GP).

Methods: cross-sectional Italian survey (2007-10); 107 GP (89% of the expected sample) enrolled patients with asthma/rhinitis diagnosis and pharmacologic treatment and/or rhinitis/asthma symptoms in the last 12 months.

For each patient (n=1820), a questionnaire was filled in by GPs on: diagnosis of allergopathies, asthma and rhinitis severity according to GL, instrumental tests used for diagnosis/monitoring, educational activity, drug prescriptions for asthma/rhinitis.

Results: patients are: 47% rhinitic (7% moderate-severe persistent), 25% asthmatics (2% severe persistent) 28% with both asthma and rhinitis (AR) (8% with moderate-severe persistent rhinitis, 6% with severe persistent asthma).

The prevalence of prescribed instrumental tests for rhinitis diagnosis/monitoring ranges between 32% (objective nasal test) and 62% (prick test) while for asthma is between 6% (exhaled nitric oxide) and 87% (spirometry). AR increases the prevalence of prescribed instrumental tests for rhinitis and decreases that for asthma instrumental investigations.

58% of rhinitic patients, 68% of asthmatics and 68% of AR subjects receive a specific education (regular controls, written therapeutic plans, auto-monitoring education, support groups). 35% of rhinitic, 29% of asthmatics and 26% of AR patients receive general information. 6% of rhinitic, 3% of asthmatics and 5% of AR patients do not receive any educational intervention.

Considering the prescribed pharmaco-therapeutic categories, 43% of rhinitic, 77% of asthmatic and 54% of AR subjects do not receive an appropriate treatment in relation to the severity level.

Conclusions: contrary to GL recommendations, use of instrumental tests for asthma and rhinitis diagnosis/monitoring appears still incomplete as well as use of specific educational support for the patients. Anyway, it is the pharmacologic treatment for rhinitis and even more for asthma that presents the lower level of implementation within the general practice.

Work supported by the Italian Medicines Agency (AIFA), contract no. FARM5JYS5A.