Abstract
Asthma often remains uncontrolled, despite the fact that the pharmacological treatment has undergone large changes. We studied changes in the treatment of asthma over a 20-year period and identified factors associated with the regular use of inhaled corticosteroid (ICS) treatment.
Changes in the use of medication were determined in 4617 randomly selected subjects, while changes in adults with persistent asthma were analysed in 369 participants. The study compares data from three surveys in 24 centres in 11 countries.
The use of ICSs increased from 1.7% to 5.9% in the general population and the regular use of ICSs increased from 19% to 34% among persistent asthmatic subjects. The proportion of asthmatic subjects reporting asthma attacks in the last 12 months decreased, while the proportion that had seen a doctor in the last 12 months remained unchanged (42%). Subjects with asthma who had experienced attacks or had seen a doctor were more likely to use ICSs on a regular basis.
Although ICS use has increased, only one-third of subjects with persistent asthma take ICSs on a regular basis. Less than half had seen a doctor during the last year. This indicates that underuse of ICSs and lack of regular healthcare contacts remains a problem in the management of asthma.
Abstract
Despite increased ICS use, only 34% of subjects with persistent asthma take ICSs on a regular basis; <50% have seen a doctor in the last year. Underuse of ICSs and lack of regular healthcare contacts remains a problem in asthma. http://ow.ly/GUZ630mZkVN
Footnotes
The members of the ECRHS I scientific team. Coordinating Centre (London): P. Burney, S. Chinn, C. Luczynska†, D. Jarvis, E. Lai. Project Management Group: P. Burney (Project Leader; UK), S. Chinn (UK), C. Luczynska† (UK), D. Jarvis (UK), P. Vermeire† (Antwerp), H. Kesteloot (Leuven), J. Bousquet (Montpellier), D. Nowak (Hamburg), J. Prichard† (Dublin), R. de Marco† (Verona), B. Rijcken (Groningen), J.M. Anto (Barcelona), J. Sunyer (Barcelona), J. Alves (Oporto), G. Boman (Uppsala), N. Nielsen (Copenhagen), P. Paoletti (Pisa). Participating Centres: Australia: Melbourne (M. Abramson, J. Kutin); Belgium: Antwerp South/Antwerp Central (P. Vermeire, F. van Bastelaer); Estonia: Tartu (R. Jõgi); France: Bordeaux (A. Taytard), Grenoble (I. Pin, C. Pison), Paris (F. Neukirch, R. Liard), Montpellier (J. Bousquet, J. Knani); Germany: Erfurt (H-E. Wichmann, J. Heinrich), Hamburg (H. Magnussen, D. Nowak); Iceland: Reykjavik (T. Gislason, D. Gislason); Italy: Pavia (A. Marinoni, I. Cerveri), Turin (M. Bugiani, C. Bucca, C. Romano), Verona (R. de Marco†, L. Cascio, C. Campello); the Netherlands: Groningen (J. Droste, M. Kerkhof); Norway: Bergen (A. Gulsvik, E. Omenaas); Spain: Albacete (J. Martinez-Moratalla, E. Almar, A. Mateos, M. Arévalo, A. Sánchez, M. Vizcaya, X. Aguilar, A. Teixidó), Barcelona (J.M. Antó, M. Kogevinas, J. Sunyer, F. Burgos, J. Castellsagué, J. Roca, JB. Soriano, A. Tobías), Galdakao (N. Muiñozguren, J. Ramos González, A. Capelastegui), Huelva (J. Maldonado Pérez, A. Pereira, J. Sánchez), Oviedo (J. Quiros, I. Huerta, F. Payo); Sweden: Gothenburg (N. Lindholm, P. Plaschke), Uppsala (G. Boman, C. Janson, E. Björnsson), Umeå (L. Rosenhall, E. Norrman, B. Lundbäck); Switzerland: Basel (U. Ackermann-Liebrich, N. Küenzli, A. Perruchoud); UK: Caerphilly (M. Burr†, J. Layzell), Ipswich (R. Hall), Norwich (B. Harrison).
The members of the ECRHS II scientific team. Coordinating Centre (London): P. Burney, S. Chinn, C. Luczynska†, D. Jarvis, J. Knox. Project Management Group: P. Burney (Project Leader; UK), S. Chinn (UK), C. Luczynska† (UK), D. Jarvis (UK), P. Vermeire† (Antwerp), J. Bousquet (Montpellier), J. Heinrich (Erfurt), M. Wjst (Munich), R. de Marco† (Verona), J.M. Anto (Barcelona), J. Sunyer (Barcelona), C. Janson (Uppsala), U. Ackermann-Liebrich (Basel), N. Kuenzli (University of Basel and University of Southern California, LA, USA), F. Neukirch (Paris). Participating Centres: Australia: Melbourne (M. Abramson, E.H. Walters, J. Raven); Belgium: Antwerp South/Antwerp Central (P. Vermeire, J. Weyler, M. van Sprundel, V. Nelen); Estonia: Tartu (R. Jõgi, A. Soon); France: Bordeaux (A. Taytard, C. Raherison), Grenoble (I. Pin, J. Ferran-Quentin), Paris (F. Neukirch, B. Leynaert, R. Liard, M. Zureik), Montpellier (J. Bousquet, P.J. Bousquet); Germany: Erfurt (J. Heinrich, M. Wjst, C. Frye, I. Meyer), Hamburg (H. Magnussen, D. Nowak); Iceland: Reykjavik (T. Gislason, E. Bjornsson, D. Gislason, K.B. Jörundsdóttir); Italy: Pavia (A. Marinoni, S. Villani, M. Ponzio, F. Frigerio, M. Comelli, M. Grassi, I. Cerveri, A. Corsico), Turin (R. Bono, M. Bugiani, P. Piccioni, E. Caria, A. Carosso, E. Migliore, G. Castiglioni), Verona (R. de Marco†, G. Verlato, E. Zanolin, S. Accordini, A. Poli, V. Lo Cascio, M. Ferrari, I. Cazzoletti); the Netherlands: Groningen (M. Kerkhof); Norway: Bergen (A. Gulsvik, E. Omenaas, C. Svanes, B. Laerum); Spain: Albacete (J. Martinez-Moratalla Rovira, E. Almar, M. Arévalo, C. Boix, G. González, J.M. Ignacio García, J. Solera, J. Damián), Barcelona (J.M. Antó, J. Sunyer, M. Kogevinas, J.P. Zock, X. Basagaña, A. Jaen, F. Burgos, C. Acosta), Galdakao (N. Muñozguren, J. Ramos, I. Urrutia, U. Aguirre), Huelva (J. Maldonado, A. Pereira, J.L. Sanchez), Oviedo (F. Payo, I. Huerta, A. de la Vega, L. Palenciano, J. Azofra, A. Cañada); Sweden: Gothenburg (K. Toren, L. Lillienberg, A.C. Olin, B. Balder, A. Pfeifer-Nilsson, R. Sundberg), Uppsala (C. Janson, G. Boman, D. Norback, G. Wieslander, M. Gunnbjornsdottir), Umeå (E. Norrman, M. Soderberg, K.A. Franklin, B. Lundback, B. Forsberg, L. Nystrom); Switzerland: Basel (N. Küenzli, B. Dibbert, M. Hazenkamp, M. Brutsche, U. Ackermann-Liebrich); UK: Caerphilly (M. Burr†, J. Layzell), Ipswich (D. Jarvis, R. Hall, D. Seaton), Norwich (D. Jarvis, B. Harrison).
The members of the ECRHS III scientific team. Coordinating Centre (London): D. Jarvis, P. Burney, M. Tumilty, J. Potts. Project Management Group: D. Jarvis (UK), P. Burney (UK), J. Heinrich (Erfurt), R. de Marco† (Verona), J.M. Anto (Barcelona), C. Janson (Uppsala), K. Toren (Gothenburg), T. Gislasson (Iceland), T. Rochat (Basel), B. Leyneart (Paris), C. Svanes (Bergen), J. Weyler (Antwerp), J.P. Zock (Barcelona). Participating Centres: Australia: Melbourne (M. Abramson, G. Benke, S. Dharmage, B. Thompson, S. Kaushik, M. Matheson); Belgium: South Antwerp/Antwerp City (J. Weyler, H. Bentouhami, V. Nelen); Estonia: Tartu (R. Jõgi, H. Orru); France: Bordeaux (C. Raherison, P.O. Girodet), Grenoble (I. Pin, V. Siroux, J. Ferran, J.L. Cracowski), Montpellier (P. Demoly, A. Bourdin, I. Vachier), Paris (B. Leynaert, D. Soussan, D. Courbon, C. Neukirch, L. Alavoine, X. Duval, I. Poirier); Germany: Erfurt (J. Heinrich, E. Becker, G. Woelke, O. Manuwald), Hamburg (H. Magnussen, D. Nowak, A-M. Kirsten); Iceland: Reykjavik (T. Gislason, B. Benediktsdottir, D. Gislason, E.S. Arnardottir, M. Clausen, G. Gudmundsson, L. Gudmundsdottir, H. Palsdottir, K. Olafsdottir, S. Sigmundsdottir, K. Bara-Jörundsdottir); Italy: Pavia (I. Cerveri, A. Corsico, A. Grosso, F. Albicini, E. Gini, E.M. Di Vincenzo, V. Ronzoni, S. Villani, F. Campanella, M. Gnesi, F. Manzoni, L. Rossi, O. Ferraro), Turin (M. Bugiani, R. Bono, P. Piccioni, R. Tassinari, V. Bellisario, G. Trucco), Verona (R. de Marco†, S. Accordini, L. Calciano, L. Cazzoletti, M. Ferrari, A.M. Fratta Pasini, F. Locatelli, P. Marchetti, A. Marcon, E. Montoli, G. Nguyen, M. Olivieri, C. Papadopoulou, C. Posenato, G. Pesce, P. Vallerio, G. Verlato, E. Zanolin); the Netherlands: Groningen (H.M. Boezen); Norway: Bergen (C. Svanes, E. Omenaas, A. Johannessen, T. Skorge, F. Gomez Real); Spain: Albacete (J. Martinez-Moratalla Rovira, E. Almar, A. Mateos, S. García, A. Núñez, P. López, R. Sánchez, E. Mancebo), Barcelona (J-M. Antó, J.P. Zock, J. Garcia-Aymerich, M. Kogevinas, X. Basagaña, A.E. Carsin, F. Burgos, C. Sanjuas, S. Guerra, B. Jacquemin, P. Davdand Galdakao: N. Muñozguren, I. Urrutia, U. Aguirre, S. Pascual), Huelva (J. Antonio Maldonado, A. Pereira, J.L. Sánchez, L. Palacios), Oviedo (F. Payo, I. Huerta, N. Sánchez, M. Fernández, B. Robles); Sweden: Gothenburg (K. Torén, M. Holm, J-L. Kim, A-C. Olin, A. Dahlman-Höglund), Umeå (B. Forsberg, L. Braback, L. Modig, B. Järvholm, H. Bertilsson, K.A. Franklin, C. Wahlgreen), Uppsala (B. Andersson, D. Norback, U. Spetz Nystrom, G. Wieslander, G.M. Bodinaa Lund, K. Nisser); Switzerland: Basel (N.M. Probst-Hensch, N. Künzli, D. Stolz, C. Schindler, T. Rochat, J.M. Gaspoz, E. Zemp Stutz, M. Adam, C. Autenrieth, I. Curjuric, J. Dratva, A. Di Pasquale, R. Ducret-Stich, E. Fischer, L. Grize, A. Hensel, D. Keidel, A. Kumar, M. Imboden, N. Maire, A. Mehta, H. Phuleria, M. Ragettli, M. Ritter, E. Schaffner, G.A. Thun, A. Ineichen, T. Schikowski, M. Tarantino, M. Tsai); UK: London (P. Burney, D. Jarvis, S. Kapur, R. Newson, J. Potts), Ipswich (D. Jarvis, M. Tumilty, N. Innes), Norwich (D. Jarvis, M. Tumilty, A. Wilson).
Conflict of interest: J.A. Gullón has nothing to disclose.
Conflict of interest: R. Jogi reports receiving Estonian Research Council Personal Research Grant 562 during the conduct of the study; consultancy and lecture fees from GSK, Boehringer and Novartis, and travel, accommodation and meeting expenses from GSK and Boehringer.
Conflict of interest: A. Johannessen has nothing to disclose.
Conflict of interest: V. Bellisario has nothing to disclose.
Conflict of interest: C. Janson reports receiving personal fees for lectures and advisory boards from AstraZeneca, Boehringer Ingelheim, Chiesi, Novartis and Teva, and for advisory boards from GSK, outside the submitted work.
Conflict of interest: D. Jarvis reports receiving grants from Medical Research Council, during the conduct of the study.
Conflict of interest: D. Gislason has nothing to disclose.
Conflict of interest: I. Pin reports receiving travel grants from MSD, presentation fees from Teva, and both from AstraZeneca, outside the submitted work.
Conflict of interest: J.L. Sánchez-Ramos has nothing to disclose.
Conflict of interest: Isa Cerveri has nothing to disclose.
Conflict of interest: S. Accordini has nothing to disclose.
Conflict of interest: J.J. Weyler has nothing to disclose.
Conflict of interest: R. Nielsen reports receiving grants from Boehringer Ingelheim and Novartis, personal fees from AstraZeneca, and grants and personal fees from GSK, outside the submitted work.
Conflict of interest: L. Cazzoletti has nothing to disclose.
Conflict of interest: J. Garcia-Aymerich has nothing to disclose.
Conflict of interest: M. Holm has nothing to disclose.
Conflict of interest: J. Martinez-Moratalla Rovira has nothing to disclose.
Conflict of interest: V. Siroux reports receiving speakers’ honoraria from AstraZeneca, Novartis and Teva, outside the submitted work.
Conflict of interest: A. Corsico has nothing to disclose.
Conflict of interest: A. Marcon has nothing to disclose.
Conflict of interest: S. Chanoine reports personal fees for board membership from AstraZeneca, and travel, accommodation and meeting expenses from Boehringer Ingelheim, Actelion Pharmaceuticals and MSD, outside the submitted work.
Conflict of interest: J. Quint reports receiving grants from The Health Foundation, the MRC, the British Lung Foundation and IQVIA, grants and advisory board fees from GSK, Boehringer Ingelheim and AstraZeneca, travel fees from Chiesi and Teva, grants and speaking fees from Insmed, grants and consultancy fees from Bayer, outside the submitted work.
Conflict of interest: D.S. Ferreira reports receiving grants from the Asthma Foundation of Victoria, Allen and Hanburys, and the National Health and Medical Research Council during the conduct of the study.
Conflict of interest: D. Nowak has nothing to disclose.
Conflict of interest: A. Malinovschi has nothing to disclose.
Conflict of interest: K.A. Franklin has nothing to disclose.
Conflict of interest: J. Heinrich has nothing to disclose.
Support statement: The coordination of ECRHS I was supported by the European Commission. The following grants helped to fund the local studies. Australia: Asthma Foundation of Victoria, Allen and Hanburys. Belgium: Belgian Science Policy Office, National Fund for Scientific Research. Denmark: Aarhus (R. Dahl, M. Iversen). Estonia: Estonian Science Foundation (1088). France: Ministère de la Santé, Glaxo France, Insitut Pneumologique d'Aquitaine, Contrat de Plan Etat-Région Languedoc-Rousillon, CNMATS, CNMRT (90MR/10 and 91AF/6), Ministre delegué de la santé, RNSP, France, GSF. Germany: Bundesminister für Forschung und Technologie. Greece: The Greek Secretary General of Research and Technology, Fisons, Astra and Boehringer Ingelheim. Italy: Ministero dell'Università e della Ricerca Scientifica e Tecnologica, CNR, Regione Veneto (RSF 381/05.93). The Netherlands: Dutch Ministry of Wellbeing, Public Health and Culture and the Netherlands Asthma Foundation. Norway: Norwegian Research Council project 101422/310. Portugal: Glaxo Farmacêutica Lda, Sandoz Portugesa. Spain: Fondo de Investigación Sanitaria (91/0016-060-05/E, 92/0319 and 93/0393), Hospital General de Albacete, Hospital General Juan Ramón Jiménez, Dirección Regional de Salud Pública (Consejería de Sanidad del Principado de Asturias), CIRIT (1997 SGR 00079) and Servicio Andaluz de Salud. Sweden: Swedish Medical Research Council, Swedish Heart Lung Foundation, Swedish Association against Asthma and Allergy. Switzerland: Swiss National Science Foundation (4026-28099). UK: National Asthma Campaign, British Lung Foundation, Dept of Health, South Thames Regional Health Authority.
The coordination of ECRHS II was supported by the European Commission. The following grants helped to fund the local studies. Australia: National Health and Medical Research Council. Belgium: Antwerp: Fund for Scientific Research (G.0402.00), University of Antwerp, Flemish Health Ministry. Estonia: Tartu Estonian Science Foundation (4350). France: all: Programme Hospitalier de Recherche Clinique–Direction de la Recherche Clinique (DRC) de Grenoble 2000 number 2610, Ministry of Health, Ministère de l'Emploi et de la Solidarité, Direction Génerale de la Santé, CHU de Grenoble; Bordeaux: Institut Pneumologique d'Aquitaine; Grenoble: Comite des Maladies Respiratoires de l'Isere; Montpellier: Aventis (France), Direction Regionale des Affaires Sanitaires et Sociales Languedoc-Roussillon; Paris: Union Chimique Belge-Pharma (France), Aventis (France), Glaxo France. Germany: Erfurt: GSF-National Research Centre for Environment and Health, Deutsche Forschungsgemeinschaft (FR1526/1-1); Hamburg: GSF-National Research Centre for Environment and Health, Deutsche Forschungsgemeinschaft (MA 711/4-1). Iceland: Icelandic Research Council, Icelandic University Hospital Fund; Italy: Pavia: GSK Italy, Italian Ministry of University and Scientific and Technological Research (MURST), Local University Funding for Research 1998 and 1999; Turin: Azienda Sanitaria Locale 4 Regione Piemonte (Italy), Azienda Ospedaliera Centro Traumatologico Ospedaliero/Centro Traumatologico Ortopedico–Istituto Clinico Ortopedico Regina Maria Adelaide Regione Piemonte; Verona: Ministero dell'Universitá e della Ricerca Scientifica (MURST), Glaxo Wellcome SpA. Norway: Bergen: Norwegian Research Council, Norwegian Asthma and Allergy Association, Glaxo Wellcome AS, Norway Research Fund. Spain: Fondo de Investigacion Santarias (97/0035-01, 99/0034-01 and 99/0034 02), Hospital Universitario de Albacete, Consejeria de Sanidad; Barcelona: Sociedad Espanola de Neumología y Cirugía Toracica, Public Health Service (R01 HL62633-01), Fondo de Investigaciones Santarias (97/0035-01, 99/0034-01 and 99/0034-02), Consell Interdepartamental de Recerca i Innovació Tecnològica (1999SGR 00241) Instituto de Salud Carlos III: Red de Centros de Epidemiología y Salud Pública (C03/09), Red de Bases moleculares y fisiológicas de las Enfermedades Respiratorias (C03/011) and Red de Grupos Infancia y Medio Ambiente (G03/176); Huelva: Fondo de Investigaciones Santarias (97/0035-01, 99/0034-01 and 99/0034-02); Galdakao: Basque Health Dept Oviedo: Fondo de Investigaciones Sanitaria (97/0035-02, 97/0035, 99/0034-01, 99/0034-02, 99/0034-04, 99/0034-06, 99/350 and 99/0034-07), European Commission (EU-PEAL PL01237), Generalitat de Catalunya (CIRIT 1999 SGR 00214), Hospital Universitario de Albacete, Sociedad Española de Neumología y Cirugía Torácica (SEPAR R01 HL62633-01) Red de Centros de Epidemiología y Salud Pública (C03/09), Red de Bases moleculares y fisiológicas de las Enfermedades Respiratorias (C03/011) and Red de Grupos Infancia y Medio Ambiente (G03/176) (97/0035-01, 99/0034-01 and 99/0034-02). Sweden: Swedish Heart Lung Foundation, Swedish Foundation for Health Care Sciences and Allergy Research, Swedish Asthma and Allergy Foundation, Swedish Cancer and Allergy Foundation, Swedish Council for Working Life and Social Research (FAS). Switzerland: Swiss National Science Foundation, Swiss Federal Office for Education and Science, Swiss National Accident Insurance Fund. UK: Asthma UK (formerly known as National Asthma Campaign).
The coordination of ECRHS III was supported by the Medical Research Council (92091). The following grants helped to fund the local studies. Australia: National Health and Medical Research Council. Belgium: Research Foundation Flanders (FWO; .0.410.08.N.10) (both sites). Estonia: Tartu: SF0180060s09 from the Estonian Ministry of Education. France: all: Ministère de la Santé. Programme Hospitalier de Recherche Clinique (PHRC) national 2010; Bordeaux: INSERM U897 Université Bordeaux segalen; Grenoble: Comite Scientifique AGIRadom 2011; Paris: Agence Nationale de la Santé, Région Ile de France, domaine d'intérêt majeur (DIM). Germany: Erfurt: German Research Foundation (HE 3294/10-1); Hamburg: German Research Foundation (MA 711/6-1 and NO 262/7-1). Iceland: The Landspitali University Hospital Research Fund, University of Iceland Research Fund, ResMed Foundation (CA, USA), Orkuveita Reykjavikur (Geothermal Plant), Vegagerðin (The Icelandic Road Administration). Italy: all: Italian Ministry of Health, Chiesi Farmaceutici SpA; Verona: funded by Cariverona Foundation, Education Ministry (MIUR). Norway: Norwegian Research Council (214123), Western Norway Regional Health Authorities (911631), Bergen Medical Research Foundation. Spain: Fondo de Investigación Sanitaria (PS09/02457, PS09/00716 09/01511, PS09/02185 and PS09/03190), Servicio Andaluz de Salud, Sociedad Española de Neumología y Cirurgía Torácica (SEPAR 1001/2010), Fondo de Investigación Sanitaria (PS09/02457); Barcelona: Fondo de Investigación Sanitaria (PS09/00716); Galdakao: Fondo de Investigación Sanitaria (09/01511); Huelva: Fondo de Investigación Sanitaria (PS09/02185) and Servicio Andaluz de Salud; Oviedo: Fondo de Investigación Sanitaria (PS09/03190). Sweden: Swedish Heart and Lung Foundation, Swedish Asthma and Allergy Association, Swedish Association against Lung and Heart Disease, Swedish Research Council for Health, Working Life and Welfare (FORTE); Gothenburg: further funding from the Swedish Council for Working Life and Social Research; Umeå: Vasterbotten Country Council ALF grant. Switzerland: Swiss National Science Foundation (33CSCO-134276/1, 33CSCO-108796, 3247BO-104283, 3247BO-104288, 3247BO-104284, 3247-065896, 3100-059302, 3200-052720, 3200-042532 and 4026-028099), The Federal Office for Forest, Environment and Landscape, The Federal Office of Public Health, The Federal Office of Roads and Transport, the Canton's Government of Aargan, Basel-Stadt, Basel-Land, Geneva, Luzern, Ticino, Valais and Zürich, the Swiss Lung League, the Canton's Lung League of Basel-Stadt/Basel, Landschaft, Geneva, Ticino, Valais and Zurich, SUVA, Freiwillige Akademische Gesellschaft, UBS Wealth Foundation, Talecris Biotherapeutics GmbH, Abbott Diagnostics, European Commission 018996 (GABRIEL), Wellcome Trust (WT 084703MA). UK: Medical Research Council (92091); support also provided by the National Institute for Health Research through the Primary Care Research Network.
- Received May 24, 2018.
- Accepted November 28, 2018.
- Copyright ©ERS 2019
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