engleski

GINA guidelines in Croatia

Because of a significant increase in asthma prevalence, widespread activities were undertaken in Croatia to implement the program of the Global Initiative for Asthma - GINA (1). These activities consisted of a series of workshops for general practitioners, continuing education for pharmacists, and "training for trainers" courses for chest physicians. Since 1996, the program has been held in all 29 subsidiaries of Croatian Medical Association, totaling 4080 participants, with distribution of more than 6000 translated GINA guidelines. Throughout the program, the early prescription of inhaled corticosteroids (ICS) and the importance of a stepwise approach in gaining long-term asthma control were emphasized (2). It is difficult to measure the benefits of educational activities that aim mostly to increase general practitioners' awareness of proper management of asthmatic patients. Attentive monitoring of changes in attitude towards prescribing recommended drugs is one possible means. Therefore, the present study aimed to investigate whether GINA implementation activities have succeeded in increasing the prescription of ICS in asthma. Fig. 1 shows the manifold increase in prescription of ICS observed during the period 1991-2000. The utilization of ICS was expressed as a total weight (g), calculated by multiplying the number of drug units sold by the number of doses in each unit, and by the weight of a single dose. ICS were expressed as weight of beclomethasone, using an equivalent weight basis for other ICS. We hypothesized that increased prescription of ICS would improve the global control of asthma, which could be reflected in a decreased hospital admission rate (3). Therefore, the total dispensation of ICS was correlated (piecewise linear regression with breakpoint) with hospitalization rates for asthma (hospital discharge data sets 1991-2000, Croatian Institute for Public Health). The increased prescription of ICS was found to correlate significantly with the trend for reversal in hospitalization rates for asthma (with breakpoint in 1997, r = 0.955, P < 0.01). Our results suggest that widespread educational activities at national level might help in changing attitude toward the treatment of asthma.

asthma; guidelines; inhaled corticosteroids

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