Effect of not appropriate treatment in severe/not controlled asthma: The AGAVE study

Background: application of international guidelines is expected to guarantee a better disease management and control in asthmatic patients. Aim: to assess the association between not appropriate treatment and disease control outcomes in outpatients, through implementation of the on-line Italian Registry of severe/not controlled asthma (SNCA). Methods: longitudinal observational study in Italian specialistic centres on SNCA patients. Pulmonologists collected information on asthma control, management and risk factors at baseline and during the control visit. Data were directly entered via web in the on-line Registry. SNCA treatment was considered appropriate if used drugs were conform with pharmacological treatment recommended in the GINA guidelines. To assess the effects of a not appropriate treatment over time, the relationship between subjects with a longitudinal appropriate (LA)/not appropriate (LNA) treatment and follow-up control outcomes was analyzed using univariate and multivariate analyses (adjusting for age, sex, BMI). Results: the Registry contains information on 195 longitudinal cases: 45 (23.1%) LNA. Through logistic regression model, being LNA vs being LA was significantly associated with the following indicators of uncontrolled asthma: not/partially controlled asthma (OR 12.6, 95% CI 1.8-86.1), >2 times oral steroids use (7.7, 1.1-54.3) and hospitalizations (14.4, 1.4-144.3). There was a borderline relation with: >1 exacerbation (2.6, 0.9-7.8), emergency department visits (11.4, 0.7-175.2). Conclusions: within the Italian SNCA registry, a not appropriate treatment is related to lower disease control. Funded by Italian Medicines Agency (AIFA), Independent Research Contract FARM8YRYZC.