Sebastiano Guarnaccia, Mariateresa Chiarini, Alessandro Gaffurini, Andrea Lombardi, Emanuele D'Agata, Giusy Boldini, Adriana Boldi, Raffaele Spiazzi

S. Guarnaccia (sebastiano.guarnaccia@spedalicivili.brescia.it) Centro “Io e l‟Asma”, Laboratorio Clinico Pedagogico e Ricerca Biomedica, Spedali Civili, Brescia, Italy

www.ioeasma.it

"Io e l'Asma", a clinical asthma management programme

developed over a period of ten years, implementing

international guidelines into daily practice

AIMS

To analyse the evolution and the adherence of the “Io e l'Asma” programme

implementing International Asthma Guidelines based on the clinical

pathway for children over a period if ten years.

STUDY PROGRAM

1999−2002

The pulmonologist is the sole responsible for all aspects of the

management: diagnosis , therapy, education and follow−up.

The primary care physician and the nurse are merely supportive.

An educational book and a CD−ROM are made available

for patients and families.

2003−2005

A holistic approach is developed with a team of specialists

(pulmonologist, resident, nurse, clinical pedagogue,

web−engineer) working on its own without co−ordination or a

shared plan. A diagnostic therapeutic protocol based on the

International Guidelines is developed with

primary care physicians.

2006−2008

All team members now create a framework following a

sheduled diagnostic−therapeutic− clinical pathway (basis:

3 specialist visits at 0, 6−8, 12−16 weeks, followed

by 6−monthly visits).

RESULTS

A total of 1140 consecutive children aged 1 to 15 participated in

the three periods above mentioned. The average number of

patients for year, in the 1999−2002 and 2003− 2005 is 57 and

121; the number of patients in the 2006, 2007 and 2008 are 145,

168, 176 respectively. The mean number of specialist visits was

2.2 and 3.2 in the first and second periods and consequently the

mean length of follow−up was 2.3 and 5.85 months.

The mean length of follow−up for 2006, 2007 and 2008 was

respectively 5.04, 3.63 and 3.85 months. The drop−out rate was

60.4% and 19.5% in the first 2 periods; in 2006 it was 18.1%,

in 2007, 17. 3% and in 2008 an outstanding 4.5%.

CONCLUSIONS

“Io e l„Asma”, which implements international guidelines,

shows how following a structured pathway (three specialist

visits in the third period) reduced absenteeism drastically.

As a result, patient and family adherence increased

significantly and had a highly favorable effect on daily

management.

1999-2002

2003-2005

2006-2008

0

1

2

3

4

5

6

Mean length of follow−up

0%

10%

20%

30%

40%

50%

60%

70%

1999−2002 2003− 2005

2006 2007 2008

Drop−out rate

02040

60

80

100

120

140

160

180

Number of patients