Inhaler treatment prescription in adults in a primary care setting

Aim of the study was to assess the treatment of airway obstructive diseases in a sample of adult patients in a primary care setting in the city of Palermo, Southern Italy. Seventeen general practitioners (GPs) participated in the study performed between January and June 2014. 583 adult patients (323 males) fulfilled a respiratory questionnaire and performed a spirometry. We evaluated doctor diagnosis of: asthma (A), chronic obstructive pulmonary disease (COPD), asthma-chronic obstructive pulmonary disease (ACOS) and inhaler respiratory treatment. A cut-off of FEV1/FVC < 0.70 was considered as marker of airway obstruction (AO). Subjects with A were 8%; COPD were 12; ACOS were 4%; subjects not reporting respiratory disease (NRD) were 76%. Inhaler treatment prevalence was: 56%-A; 40%-COPD; 62%-ACOS; 7%-NRD. Airway obstruction was found in 95 (16.3%) subjects: 26%-A; 30%-COPD; 43%-ACOS; 10%- NRD. Only 52% of AO subjects reported inhaler treatment: 83%-A; 69%-COPD; 67%-ACOS; 29%- NRD. Inhaler treatment prevalence was: 8%-long-acting ?2-agonist (LABA) and/or longacting muscarinic antagonist (LAMA); 33%-LAMA and/or LABA and inhaled corticosteroid (ICS); 26%-LAMA and LABA and ICS; 2%-ICS; 31%-Other. In a logistic regression model, wheezing (OR=4.50), cough (OR= 2.12), and dyspnea (OR= 2.22), were predictors of treatment in overall sample, when adjusted for age, sex and smoking habit. In AO dyspnea was the best predictor of inhaler respiratory treatment (OR= 3.61). This study points out that in a sample of adults in a primary care setting the inhaler respiratory treatment is underused with respect to diagnosis and airway obstruction. Respiratory symptoms, in particular dyspnea, seems to guide the prescription of GPs.