Application and implementation of the GINA asthma guidelines by specialist and primary care physicians: a longitudinal follow-up study on 264 children

^*Sebastiano Guarnaccia^a, Andrea Lombardi^a, Alessandro Gaffurini^a, Mariateresa Chiarini^a, Serena Domenighini^a, Emanuele D’Agata^a, Richard Fabian Schumacher^b, Raffaele Spiazzi^a,b, Luigi D Notarangelo<sup>b,c

a</sup> Laboratorio Clinico-Pedagogico e Ricerca Biomedica, Ospedale dei Bambini, Brescia, Italy

^b University Children’s Hospital, Spedali Civili, Brescia, Italy

^c Children’s Hospital, Harvard University, Boston, MA, USA

Received 19 March 2007 • Accepted 28 July 2007 • Online 21 December 2007

Abstract
AIMS: To implement GINA guidelines and to assess their impact on the management of childhood asthma. METHODS: A working group of primary care physicians (PCPs) and specialists developed a GINA-based clinical pathway. We then monitored the impact on 385 children (aged 0-15 years) referred to the respiratory outpatients clinic at the University Children’s Hospital, Brescia, Italy by 179 PCPs between September 2003 and July 2005. RESULTS: Mean follow-up for 264 children with complete datasets was 10 months. Guidelines were followed by 94.6% of the PCPs. 98.6% of children learned to manage exacerbations. Half of the patients with persistent symptoms became intermittently symptomatic. Maintenance treatment was suspended in 47.2%, reduced in 27.6%, and increased in 4.9%. Asthma severity diminished (p<0.0001) and requirement for medication for exacerbations was significantly reduced (p<0.0001). CONCLUSIONS: Regular specialist visits, a website, and a written management plan shared by all those involved, led to clinical improvements as well as a reduction in, and more efficient use of, asthma medication.

Keywords
Asthma management, GINA guidelines, clinical pathway, primary/specialist care
 

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