In Europe, as on other continents, bronchial asthma is a common disorder with widely variable clinical features. It is frequently not diagnosed and, if diagnosed, its severity is often underestimated by the medical profession as well as by patients and their families. Failure to diagnose or to correctly estimate the severity leads to considerable undertreatment. Moreover, in few other chronic conditions have more divergent opinions been noted concerning the correct type and order of treatment to be applied to the chronic state of the disease, as well as to its acute exacerbations. This was also brought out by a pilot survey conducted on the basis of a questionnaire among 68 chest physicians from seven European countries during the summer of 1983; although clear patterns of responses emerged among the physicians of each country, there was considerable disagreement among countries on the proper choice and dosage of drugs and ventolin inhalers for asthma therapy. Because of the interest generated by the presentation and the discussion of this survey at the Second Annual Meeting of the European Society of Pneumology in Edinburgh, it was decided to enlarge the scope into a complete European Audit on Diagnosis and Treatment of Asthma, covering all major countries of western Europe and using an improved and extended questionnaire.
Methodology of the 1984 European Audit
The questionnaire now also included questions on diagnosis and management of asthma, as well as on patient information and education. However, the emphasis was on treatment of chronic (stable) asthma, both in adults and in children. The main questions were the following:
1. In patients whose asthma is stable and not acutely deteriorating:
a. what is the considered order (sequence) of treatment for maintenance (8 choices to be numbered 1 to 8);
b. how often are a number of drugs used as “first line” therapy for regular maintenance (never, sometimes, often, always)?
2. For allergic asthma, how often is desensitisation used (same gradations as for lb)?
3. If they are used, what is the recommended metered-dose of inhaled beta-agonists and steroids (in number of puffs daily: 0-5, 5-10, 10-15,15-20, more than 20)?
4. If patients with mild/moderate asthma are unable to satisfactorily use a metered-dose inhaler, what is the order of preference (1 to 4) for an alternative delivery system?
A total of 3,305 questionnaires were mailed in June 1984 (1,075 to members of the European Society of Pneumology and 2,230 to other physicians in 16 countries). The latter were either non-pediatric (adult) specialists, pediatricians, or general practitioners and they were randomly selected within their country by the Glaxo Company. The time comes to purchase ventolin inhaler for asthma treatment via onlineasthmainhalers.com.
French questionnaires were used in France and Portugal, German in western Germany and Austria, and the Spanish version was distributed in Spain. Physicians in the other countries received the English version. In a covering letter, responding physicians were encouraged to express in their answers their average attitude in their average asthma patient.
The present analysis for 16 countries (Table 1) is based on 735 answers from adult specialists (88 percent of whom were chest specialists) and 209 responses from pediatricians. Response rates were 40 percent and 27 percent respectively. Only for seven countries did the number of responses from pediatricians exceed 10, which was considered a minimum for meaningful analysis.
For all possible answers, the percentage of the total picking that answer was calculated. For questions about frequency of use or the order of treatment, a mean score was also calculated (Table 2). Furthermore, for all percentages and scores (provided that the number of responses of all countries exceeded 10), a mean European answer (MEA) was calculated in which the answers of each country were weighted for the population supposedly served by the specialists in that country.
A brief account of the results will be given here. Two preliminary reports have already been published, and a more complete report is in preparation.
Table 1—Responses from 16 Countries