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