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ICD Code: 493. Asthma

ICD Code: 493. Article Review
Title: Rabe KF et al; "Worldwide Severity and Control of Asthma in Children and Adults: The Global Asthma Insights and Reality Surveys." Journal of Allergy and Clinical Immunology; V.114; No.1; 7/04; p40
      STUDY DESIGN: The Asthma Insights and Reality surveys are the first large-scale surveys aimed at determining international variations in the severity, control, and management of asthma in children and adults. All surveys used the same standard protocol. The surveys were conducted in 29 countries in Western Europe, Central and Eastern Europe, Asia-Pacific, the United States, and Japan. Patients with current asthma were identified as those with asthma diagnosed by a physician and who were currently taking asthma medication or had asthma attacks and symptoms during the past year.
      All participants were interviewed after consenting to participate in the survey. The symptom questionnaire was based on the American Thoracic Society questionnaire. Severe persistent asthma was indicated by the presence of daytime symptoms more than 3 times a day or nighttime sleep disruption on at least most nights. Moderate persistent asthma was defined as daytime symptoms more than 2 times per day or nighttime sleep disruption at least twice a week. Mild persistent asthma was defined as daytime symptoms at least twice a week or nighttime sleep disruption at least twice per month. Intermittent asthma was defined as fewer symptoms than those for mild persistent asthma.
      A total of 10,939 asthmatic patients (3153 children and 7786 adults) participated in the 29 countries surveyed.
      SEVERITY: There was a trend for Japanese and Asian-Pacific asthmatic patients to have less severe disease, whereas Central and Eastern Europeans reported more severe asthma symptoms.
      The distribution of asthma cases by symptom severity (severe, moderate, mild, and intermittent, respectively) in five regions was reported as follows: U.S., 19%, 22%, 16%, 43%; Western Europe, 18%, 19%, 19%, 44%; Asia-Pacific, 11%, 16%, 20%, 53%; Japan, 15%, 19%, 12%, 54%; Central and Eastern Europe, 32%, 27%, 19%, 22%.
      TREATMENT AND CONTROL: The expected association of more severe asthma symptoms with more frequent use of preventive medication, such as inhaled corticosteroids, was not observed in any of the 5 regions. All patients with persistent asthma, from mild to severe, had low use of preventive medication and high use of quick-relief medication, which is suggestive of poor asthma control.
      A similar finding across all regions was the discrepancy between the level of reported symptoms and patients’ perception of their asthma control. The surveys indicate that 32% to 49% of patients experiencing severe symptoms and 39% to 70% of patients with moderate symptoms believed their current level of asthma control to be "well" or "complete." Worldwide, there was a tendency for patients to overestimate control and underestimate severity, suggesting a willingness to accept symptoms and lifestyle limitations as unavoidable consequences of their disease.

Search Criteria: Text - Journal of Allergy and Clinical Immunology; V.114; No.1; 7/04; p40