The socio-economic burden of asthma is substantial in Europe.

BACKGROUND: Few data are available on the asthma burden in the general population. We evaluated the level and the factors associated with the asthma burden in Europe. METHODS: In 1999-2002, 1152 adult asthmatics were identified in the European Community Respiratory Health Survey (ECRHS)-II and the socio-economic burden (reduced activity days and hospital services utilization in the past 12 months) was assessed. RESULTS: The asthmatics with a light burden (only a few reduced activity days) were 13.2% (95% CI: 11.4-15.3%), whereas those with a heavy burden (many reduced activity days and/or hospital services utilization) were 14.0% (95% CI: 12.1-16.1%). The burden was strongly associated with disease severity and a lower quality of life. Obese asthmatics had a significantly increased risk of a light [relative risk ratio (RRR) = 2.17; 95% CI: 1.18-4.00] or a heavy burden (RRR = 2.77; 95% CI: 1.52-5.05) compared with normal/underweight subjects. The asthmatics with frequent respiratory symptoms showed a threefold (RRR = 2.74; 95% CI: 1.63-4.61) and sixfold (RRR = 5.76; 95% CI: 3.25-10.20) increased risk of a light or a heavy burden compared with asymptomatic asthmatics, respectively. Moreover, the lower the forced expiratory volume in 1 s % predicted, the higher the risk of a heavy burden. The coexistence with chronic cough/phlegm only increased the risk of a heavy burden (RRR = 1.88; 95% CI: 1.16-3.06). An interaction was found between gender and IgE sensitization, with nonatopic asthmatic females showing the highest risk of a heavy burden (21.6%; 95% CI: 16.9-27.1%). CONCLUSIONS: The asthma burden is substantial in Europe. A heavy burden is more common in asthmatics with obesity, frequent respiratory symptoms, low lung function, chronic cough/phlegm and in nonatopic females.

Increasing COPD awareness.

Early diagnosis and smoking cessation are the only available methods to stop the progression of chronic obstructive pulmonary disease (COPD). The aim of this study was to evaluate the effects of early detection of airflow limitation (AL) in a population with high risk for COPD, using spirometric screening. Smokers aged 40 yrs with a smoking history of 10 pack-yrs were invited to visit a local outpatient chest clinic for simple spirometry (forced expiratory volume in one second (FEV1) and forced vital capacity (FVC)). Smoking history was recorded, followed by smoking cessation advice relating the results of spirometry to the smoking behaviour. Subjects who did not fulfil the above criteria (younger and/or nonsmokers) were also screened. A total 110,355 subjects were investigated; they were aged 53.5+/-11.5 yrs and 58.2% were males. Of the total amount of subjects, 64% were current smokers, 25.1% were former smokers and 10.9% were lifelong nonsmokers. Spirometry tests were within normal values for 70.3%, and 20.3% showed signs of AL: this was mild in 7.6%, moderate in 6.7% and severe in 5.9%. The remaining 8.3% of subjects presented with a restrictive pattern of ventilatory impairment. Airflow limitation was found in 23% of smokers aged 40 yrs with a history of 10 pack-yrs. This study concluded that large-scale voluntary spirometry screening of the population with high risk for COPD detects a large number of subjects with AL.

Changes in active and passive smoking in the European Community Respiratory Health Survey.

The aim of the present investigation was to study changes and determinants for changes in active and passive smoking. The present study included 9,053 adults from 14 countries that participated in the European Community Respiratory Health Survey II. The mean follow-up period was 8.8 yrs. Change in the prevalence of active and passive smoking was expressed as absolute net change (95% confidence interval) standardised to a 10-yr period. Determinants of change were analysed and the results expressed as adjusted hazard risk ratio (HRR) or odds ratio (OR). The prevalence of active smoking declined by 5.9% (5.1-6.8) and exposure to passive smoking in nonsmokers declined by 18.4% (16.8-20.0). Subjects with a lower educational level (HRR: 0.73 (0.54-0.98) and subjects living with a smoker (HRR: 0.45 (0.34-0.59)) or with workplace smoking (HRR: 0.69 (0.50-0.95)) were less likely to quit. Low socio-economic groups were more likely to become exposed (OR: 2.21 (1.61-3.03)) and less likely to cease being exposed to passive smoking (OR: 0.48 (0.37-0.61)). In conclusion, the quitting rate was lower and the risk of exposure to passive smoking higher among subjects with lower socio-economic status. Exposure to other peoples smoking decreased quitting rates and increased the risk of starting to smoke.

Changes in the use of anti-asthmatic medication in an international cohort.

The aim of this study was to describe changes in pharmacotherapy for asthma since the early 1990s in an international cohort of young and middle-aged adults. A total of 28 centres from 14 countries participated in a longitudinal study. The study included 8,829 subjects with a mean follow-up time of 8.7 yrs. Change in the prevalence of use for medication was expressed as absolute net change (95% confidence interval) standardised to a 10-yr period. The use of anti-asthmatics was found to have increased by 3.1% (2.4-3.7%) and the prevalence of symptomatic asthma by 4.0% (3.5-4.5%). In the sample with asthma in both surveys (n=423), the use of inhaled corticosteroids increased by 12.2% (6.6-17.8%). Despite this, only 17.2% were using inhaled corticosteroids on a daily basis at follow-up. Females with continuous asthma were more likely, compared with males, and smokers with asthma, to have started using inhaled corticosteroids since the first survey. The use of anti-asthmatics has increased in a pattern consistent with current consensus on treatment. However, despite increased use of inhaled corticosteroids, a large majority of subjects with symptomatic asthma do not use this treatment on a daily basis, particularly males and smokers with asthma.

Changes in respiratory and allergic symptoms in schoolchildren from 1996 to 2002, results from the ISAAC surveys in Antwerp (Belgium).

Two cross sectional surveys (1995/1996 and 2001/2002) were carried out according to the ISAAC protocol among 6-7 and 13-14 year old schoolchildren in Antwerp, Belgium. A total of 8244 children participated in 1996 and 8159 children in 2002. No significant differences in current prevalence of asthma and asthma medication was found in 6-7 year olds and 13-14 year old girls. Significantly less asthma and asthma medication was reported by 13-14 year old boys in 2002. Symptoms of wheeze had lower occurrence in all groups in 2002, which was significant for older age group. Current prevalence of rash was significantly higher in the 6-7 year olds in 2002. No such increase was found for rash in the older age groups but they reported significantly more rhinitis. No differences were found between urban and suburban Antwerp in either survey. No clear changes in the occurrence of asthma were found for school children in Antwerp while wheeze was reported less in 2002 compared to 1996. Allergic disorders had higher occurrences in schoolchildren in 2002.

Increase in diagnosed asthma but not in symptoms in the European Community Respiratory Health Survey.

BACKGROUND: Information on the epidemiology of asthma in relation to age is limited and hampered by reporting error. To determine the change in the prevalence of asthma with age in young adults we analysed longitudinal data from the European Community Respiratory Health Survey. METHODS: A self-administered questionnaire was completed by 11 168 randomly selected subjects in 14 countries in 1991-3 when they were aged 20-44 years and 5-11 years later from 1998 to 2003. Generalised estimating equations were used to estimate net change in wheeze, nocturnal tightness in chest, shortness of breath, coughing, asthma attacks in the last 12 months, current medication, "diagnosed" asthma, and nasal allergies. RESULTS: Expressed as change in status per 10 years of follow up, subjects reporting asthma attacks in the previous 12 months increased by 0.8% of the population (95% CI 0.2 to 1.4) and asthma medication by 2.1% (95% CI 1.6 to 2.6), while no statistically significant net change was found in reported symptoms. Reported nasal allergies increased, especially in the youngest age group. CONCLUSIONS: As this cohort of young adults has aged, there has been an increase in the proportion treated for asthma but not in the proportion of those reporting symptoms suggestive of asthma. Either increased use of effective treatments has led to decreased morbidity among asthmatic subjects or those with mild disease have become more likely to label themselves as asthmatic.

An international survey of chronic obstructive pulmonary disease in young adults according to GOLD stages.

BACKGROUND: The recently published GOLD guidelines provide a new system for staging chronic obstructive pulmonary disease (COPD) from mild (stage I) to very severe (stage IV) and introduce a stage 0 (chronic cough and phlegm without airflow obstruction) that includes subjects "at risk" of developing the disease. METHODS: In order to assess the prevalence of GOLD stages of COPD in high income countries and to evaluate their association with the known risk factors for airflow obstruction, data from the European Community Respiratory Health Survey on more than 18,000 young adults (20-44 years) were analysed. RESULTS: The overall prevalence was 11.8% (95% CI 11.3 to 12.3) for stage 0, 2.5% (95% CI 2.2 to 2.7) for stage I, and 1.1% (95% CI 1.0 to 1.3) for stages II-III. Moderate to heavy smoking (> or =15 pack years) was significantly associated with both stage 0 (relative risk ratio (RRR)=4.15; 95% CI 3.55 to 4.84) and stages I+ (RRR=4.09; 95% CI 3.17 to 5.26), while subjects with stages I+ COPD had a higher likelihood of giving up smoking (RRR=1.39; 95% CI 1.04 to 1.86) than those with GOLD stage 0 (RRR=1.05; 95% CI 0.86 to 1.27). Environmental tobacco smoke had the same degree of positive association in both groups. Respiratory infections in childhood and low socioeconomic class were significantly and homogeneously associated with both groups, whereas occupational exposure was significantly associated only with stage 0. All the GOLD stages showed a significantly higher percentage of healthcare resource users than healthy subjects (p<0.001), with no difference between stage 0 and COPD. CONCLUSIONS: A considerable percentage of young adults already suffered from COPD. GOLD stage 0 was characterised by the presence of the same risk factors as COPD and by the same high demand for medical assistance.

Impact of COPD in North America and Europe in 2000: subjects' perspective of Confronting COPD International Survey.

To date, no international surveys estimating the burden of chronic obstructive pulmonary disease (COPD) in the general population have been published. The Confronting COPD International Survey aimed to quantify morbidity and burden in COPD subjects in 2000. From a total of 201,921 households screened by random-digit dialling in the USA, Canada, France, Italy, Germany, The Netherlands, Spain and the UK, 3,265 subjects with a diagnosis of COPD, chronic bronchitis or emphysema, or with symptoms of chronic bronchitis, were identified. The mean age of the subjects was 63.3 yrs and 44.2% were female. Subjects with COPD in North America and Europe appear to underestimate their morbidity, as shown by the high proportion of subjects with limitations to their basic daily life activities, frequent work loss (45.3% of COPD subjects of <65 yrs reported work loss in the past year) and frequent use of health services (13.8% of subjects required emergency care in the last year), and may be undertreated. There was a significant disparity between subjects' perception of disease severity and the degree of severity indicated by an objective breathlessness scale. Of those with the most severe breathlessness (too breathless to leave the house), 35.8% described their condition as mild or moderate, as did 60.3% of those with the next most severe degree of breathlessness (breathless after walking a few minutes on level ground). This international survey confirmed the great burden to society and high individual morbidity associated with chronic obstructive pulmonary disease in subjects in North America and Europe.

The burden of chronic obstructive pulmonary disease.

Chronic obstructive pulmonary disease (COPD) is a disease state characterized by chronic airflow limitation that is not fully reversible, with a precise definition varying between different management guidelines. The burden of COPD is considerable from all relevant viewpoints. From the perspective of society, the mortality is already considerable, and it is likely to increase from the sixth to the third most common cause of death worldwide by 2020. From the patient's perspective, COPD is responsible for disability that restricts many everyday activities, such as walking up stairs. The burden of COPD on physicians includes increasing consultations for the condition. From the perspective of healthcare payers, COPD represents an increasing burden, primarily due to the costs incurred when exacerbations require hospital treatment. Despite this considerable burden, there are many signs that the impact of COPD is not recognized. Research on COPD is currently underfunded in relation to the impact of the disease; patients only present late with symptoms; physicians may fail to diagnose the condition and healthcare payers may be failing to support treatment approaches that could reduce the number of costly hospital exacerbations. Reasons for this overall poor recognition of the burden of COPD include lack of recognition of the disease, difficulties in diagnosis, poor knowledge of COPD and nihilistic attitudes towards the condition and its treatment. Awareness of COPD could be improved with education of the public and healthcare professionals. Long-term epidemiological studies showing the impact on morbidity and mortality of different treatment approaches would also influence the setting of priorities by healthcare payers.

Asthma control and differences in management practices across seven European countries.

Failure to follow asthma management guidelines may result in poor asthma control for many patients. The Asthma Insights and Reality in Europe (AIRE) survey, a multi-national survey assessing the level of asthma control from the patients perspective in seven Western European countries, previously demonstrated that the Global Initiative for Asthma (GINA) guideline goals were not achieved in Western Europe and that both adults and children with asthma were poorly controlled. Using additional data on asthma management practices from each of the seven countries in the AIRE survey, we compared variations in asthma morbidity and asthma management practices across countries to provide insight into the reasons for poor asthma control. Asthma management practices and asthma control among adults and children with current asthma were suboptimal in each of seven countries surveyed. Among patients with symptoms of severe persistent asthma, over 40% reported their asthma was well or completely controlled. School absence due to asthma was reported by upto 52.7% of children and up to 27.6% of adult reported work absence due to asthma. Lung function testing in the past year was uncommon: ranging from 13.5% of children in the U.K. to 68.8% of adults in Germany. Written asthma management plans were used by less than 50% of adults and less than 61% of children in all seven countries. Most adults (49.5-73.0%) and a large proportion of children (38.4-70.6%) had follow-up visits for their asthma only when problems developed. The ratio of recent inhaled corticosteroid use to recent short-acting beta-agonist use was inappropriate (<1) among patients with symptoms of severe asthma in all countries. This disparity was greatest among adults in Italy and France, where recent inhaled corticosteroid use was reported by less than one in nine patients reporting recent use of short-acting bronchodialators (IS:SAB <0.11). Management practices differ between countries and additional public health interventions and resources may be necessary to reduce patient suffering. Further efforts to fully implement asthma management guidelines are required to improve asthma control in Europe.

[Dental pain]. / Les douleurs d'origine dentaire.

"The extreme variability of toothache is such that a good rule for any examiner is to consider all pains about the mouth and face to be of dental origin until provide otherwise" (Welden E. Bell). Dental caries is a disease of the calcified tissues of the teeth, characterised by demineralization of the inorganic portion and destruction of the organic substance of the tooth. The acids which affects the primary decalcifications is derived from the fermentation of starches and sugar logged in the retaining centers of the teeth. Dental caries can be classified in relation with the depth of the lesions: caries of the enamel, caries of the dentin, pulp diseases which are the result of dental caries in which bacterial invasion of the dentin and pulp tissue occurs, diseases of the periapical tissues which leads to periapical cyst, or to periapical abcess.

Increased occurrence of asthma and allergy: critical appraisal of studies using allergic sensitization, bronchial hyper-responsiveness and lung function measurements.

BACKGROUND: Many studies have reported an increase in the occurrence of asthma and respiratory allergies in recent decades, but this increase is mostly based on studies using rather subjective measurements of asthma and allergies, such as questionnaires and doctor's diagnosis. None of the reviews specifically focused on studies using more 'objective' measurements, such as sensitization (specific IgE or skin prick testing (SPT)), bronchial hyper-responsiveness (BHR) or lung function (LF). OBJECTIVE: To review articles studying a time trend of occurrence of these 'more objective' measurements. METHODS: A MEDLINE-search (1966-February 2000) was performed. The following criteria were used: population-based, using IgE, SPT, BHR or LF measurements in the same age-group at least twice, with at least 2 years between and using similar methods. RESULTS: The MEDLINE-search resulted in only 16 articles, performed in 13 populations in seven different countries. Nine articles used the same objective measurements twice in the whole population. Three of these reported a non-significant increase or decrease. The other six articles found a significant increase in at least one objective measurement and of these only three reported a consistent significant increase. CONCLUSIONS: The increase in the occurrence of reported asthma and allergy is supported by only a few articles confirming these results with 'more objective measurements'.

Epidemiology of chronic obstructive pulmonary disease.

Chronic obstructive pulmonary disease (COPD) is a leading cause of world-wide mortality and disability. On average approximately 5-15% of adults in industrialized countries have COPD defined by spirometry. In 1990, COPD was considered to be at the twelfth position world-wide as a cause of combined mortality and disability but is expected to become the fifth cause by the year 2020. COPD has a chronic long-lasting course characterized by irreversible decline of forced expiratory volume in one second (FEV1), increasing presence of dyspnoea and other respiratory symptoms, and progressive deterioration of health status. After diagnosis the 10-yr survival rate is approximately 50% with more than one-third of patients dying due to respiratory insufficiency. Several environmental exposures such as air pollution increase the risk of death in COPD patients. The aetiology of COPD is overwhelmingly dominated by smoking although many other factors could play a role. Particular genetic variants are likely to increase the susceptibility to environmental factors although little is known about which are the relevant genes. There is clear evidence about the role of the alpha-1-antitrypsin but the fraction of COPD attributable to the relevant variants is only 1%. Phenotypic traits that are considered to play a role in the development of COPD include sex, with females being at a higher risk, bronchial responsiveness and atopy. There is strong causal evidence regarding the relationship between smoking and COPD with decline in FEVI levelling off after smoking cessation. Passive smoking has been found to be associated with a small though statistically significant decline in FEV1. Other risk factors that are likely to be relevant in the development of COPD are occupation, low socioeconomic status, diet and possibly some environmental exposures in early life. Although there is accumulating evidence that oxygen therapy, pharmacological treatment and rehabilitation may improve the course of chronic obstructive pulmonary disease, preventing smoking continues to be the most relevant measure, not only to prevent chronic obstructive pulmonary disease, but also to arrest its development.

Higher occurrence of asthma-related symptoms in an urban than a suburban area in adults, but not in children.

In young adults, a higher occurrence of asthma-related symptoms was found in an urban than an adjacent suburban area in a survey performed in 1991. The authors now wondered whether such differences could be established in other age groups. The present study (in 1996) included 14,299 subjects, aged 5-75 yrs, of a random sample of the general population in the same two adjacent areas: the centre of Antwerp (Belgium) and its south suburban border. The standardized European Community Respiratory Health Survey (ECRHS) and International Study of Asthma and Allergies in Childhood (ISAAC) questionnaires were used to assess the occurrence of asthma-related symptoms. Higher rates were confirmed in urban compared to suburban Antwerp in adults (20-75 yrs), but no such area differences were found in children (5-8 and 12-15 yrs). Adjustment for a number of recorded risk factors did not seem to affect the area differences in asthma-related symptoms. Comparing the survey results of 1991 and 1996 in 20-44 yr old adults, the findings suggest a slight increase in reported respiratory symptoms in both areas. A higher occurrence of asthma symptoms was observed in the urban than suburban area in adults, but not in children. This might be explained by a progressive effect of long-term exposure to the "urban environment". However, longitudinal studies are necessary to further clarify the factors accounting for these age-related area differences.

Physician's involvement in the smoking cessation process of their patients. Results of a 1998 survey among 4,643 Belgian physicians.

This report relates to the 1,667 responses to a selfadministered mail-back questionnaire sent by BELTA to a sample of 4,643 physicians (17.3% current smokers) who are in professional contact with patients (response rate: 35.9%). Links between active smoking and disease are considered as well-demonstrated by 98.8% physicians and for passive smoking by 85.3%, for foetal consequences of smoking during pregnancy by 96.4%. Nicotine dependence is admitted by 83.3%. Interaction of smoking with drug metabolism is insufficiently known. Modulation of the specific approach of smoking cessation, according to the various stages of the cessation cycle, to the level of nicotine dependence and to the psychological status of the smoker is not sufficiently perceived by the physicians. Patient's smoking status is systematically determined by less than half the physicians, of whom nearly 90% claim to inform their smoking patients on smoking-related risks, and 84.2% to tackle the problem of cessation. The intervention is mostly limited to a firm advice, completed by nicotine replacement for a maximum of 50% of smokers (especially gum and patch). Referral to specialized structures is unfrequent (between 10 and 20%). Follow up after cessation is clearly deficient. In this retrospective study of their activity patterns, physicians' reports may reflect their intentions rather than their actual practices. We conclude that smoking issues and cessation techniques should be more intensively taught both at graduate and postgraduate levels, in order to obtain a more active behaviour of health professionals against smoking.

Does the use of antibiotics in early childhood increase the risk of asthma and allergic disease?

BACKGROUND: One of the mechanisms evoked to explain the increasing prevalences of asthma and allergy, in particular among children, is the 'Western lifestyle' or 'hygiene' hypothesis. As early childhood infections are assumed to hold a protective effect on the development of asthma and allergies, the use of antibiotics at that sensitive age may lead to an increased risk of asthma and allergy. OBJECTIVE: The aim of this study is to investigate the association between the use of antibiotics in the first year of life and the subsequent development of asthma and allergic disorders. METHODS: In a population-based sample of 7-and-8-year-old children questionnaire and skin prick test data were collected from 1206 and 675 subjects, respectively. Prevalence rates of asthma, allergic disorders and skin test positivity were compared between children with and without early life use of antibiotics, taking into account other possible risk factors including early respiratory infections. The effect of genetic predisposition was investigated by stratified analyses of children with and without parental hay fever. RESULTS: The use of antibiotics during the first year of life was significantly associated with asthma (OR = 1.7, 95% CI 1.0-3.1), hay fever (OR = 2.3, 95% CI 1.3-3.8) and eczema (OR = 1.3, 95% CI 1.0-1.8). No significant relationship was found with skin test positivity (OR = 1.1, 95% CI 0.7-1.7). After stratification for the presence of parental hay fever, children without parental hay fever did not show any significant associations between antibiotics use and asthma or allergy, whereas in children with parental hay fever the use of antibiotics was significantly related with asthma (OR = 2.3, 95% CI 1.1-5.1), hay fever (OR = 2.8, 95% CI 1.5-5.1) and eczema (OR = 1.6, 95% CI 1.0-2.6), and of borderline statistical significance with skin test positivity (OR = 1.6, 95% CI 0.9-3.0). CONCLUSION: Early childhood use of antibiotics is associated with an increased risk of developing asthma and allergic disorders in children who are predisposed to atopic immune responses. These findings support recent immunological understanding of the maturation of the immune system.

Endoscopic management of severe subglottic stenosis in Wegener's granulomatosis.

The optimal treatment for severe subglottic stenosis secondary to Wegener's granulomatosis remains controversial. We report the case of a symptomatic middle-aged woman who was successfully treated with intratracheal dilation and intralesional injection of corticosteroids. The literature related to this issue is being reviewed.

Induced sputum of patients with chronic obstructive pulmonary disease (COPD) contains adhesion-promoting, therapy-sensitive factors.

OBJECTIVE: The aim of this study was to investigate whether sputum of COPD patients before and after treatment with inhaled corticosteroids (IHC) or N-acetylcysteine (NAC) exerts any effect on the adhesion of isolated polymorphonuclear cells (PMNs) to cultured endothelial cells. METHODS: A human endothelial cell line was grown to confluence before use in adhesion experiments. PMNs were obtained from normal, non-smoking volunteers and preincubated (30 min, 37 degrees C) with diluted sputum sol obtained from COPD patients before the cells were put on the endothelial cells. RESULTS: Basal adhesion of unstimulated PMNs after 30 min at 37 degrees C in 5% CO2 was 15.9+/-1.1% (mean +/- SEM, n = 9). A significant enhancement of the adhesion to 33.0+/-1.4% (n = 11, P<0.0001) was observed with sputum obtained from COPD patients before treatment with IHC, and 34.6+/-1.5% (n = 10, P<0.0001) before treatment with NAC. Administration of IHC for 8 weeks resulted in an adhesion of 27.7+/-2.4%, which is an inhibition of 31% (n = 11, P<0.05). However, treatment for 8 weeks with NAC showed no change in the adhesion of stimulated PMNs. Long-term treatment with NAC showed a gradual decrease of adhesion (n = 9, P<0.05), whereas long-term treatment with IHC lead to an increase in adhesion (n = 10, P<0.02). CONCLUSIONS: These results indicate that factors locally produced in the airways of COPD patients may promote adhesion of neutrophils to endothelium. They further suggest that glucocorticoids may only have a short-term transient effect on adhesion, whereas NAC showed effects on the adhesion after administration for longer periods.

Clinical management of asthma in 1999: the Asthma Insights and Reality in Europe (AIRE) study.

Asthma management guidelines provide recommendations for the optimum control of asthma. This survey assessed the current levels of asthma control as reported by patients, which partly reflect the extent to which guideline recommendations are implemented. Current asthma patients were identified by telephone by screening 73,880 households in seven European countries. Designated respondents were interviewed on healthcare utilization, symptom severity, activity limitations and asthma control. Current asthma patients were identified in 3,488 households, and 2,803 patients (80.4%) completed the survey. Forty-six per cent of patients reported daytime symptoms and 30% reported asthma-related sleep disturbances, at least once a week. In the past 12 months, 25% of patients reported an unscheduled urgent care visit, 10% reported one or more emergency room visits and 7% reported overnight hospitalization due to asthma. In the past 4 weeks, more patients had used prescription quick-relief medication (63%) than inhaled corticosteroids (23%). Patient perception of asthma control did not match their symptom severity; approximately 50% of patients reporting severe persistent symptoms also considered their asthma to be completely or well controlled. The current level of asthma control in Europe falls far short of the goals for long-term asthma management. Patients' perception of asthma control is different from their actual asthma control.