Introduction: Since 2021, GINA recommendations propose 2 treatment tracks for moderate to severe asthma, Track 1 with low-dose ICS/formoterol for maintenance and symptomatic relief therapy (MART) and Track 2 with daily ICS/LABA with as-needed SABA for symptom relief.

Objectives: The APPaRENT 2 study aimed to understand real world therapy approach in 5 countries, in light of GINA reccomendations. Here we show the Italian data.

Methods: Online survey on Italian adult patients with asthma and physicians with ?4 patients per month, ?3 years clinical practice.

Results: 330 patients and 216 physicians (39% specialists, 61% GPs) participated to the survey. Most patients considered their asthma somewhat to completely controlled (90.6%), although up to 89% reported symptoms and 73% daily limitations. For physicians, symptom control in moderate patients was the most important goal vs exacerbations reduction (41% vs 33%), whereas in severe patients these outcomes are equally important. The initial treatments for patients with moderate/severe/fluctuating severity asthma were: as needed ICS/formoterol 5.6%, inhaled SABA only 0.93%, ICS/LABA combination and SABA 70.2%, low dose ICS and SABA 13.5%, MART with SABA 7.9%. Of the patients with MART prescription, 73% were also prescribed a separated rescue inhaler.

Conclusions: Patients appear to overestimate their level of asthma control, that is not aligned with their reporting of symptoms/limitations. The consolidated proactive treatment with ICS/LABA and as-needed SABA remains the preferred initial approach, in line with GINA track 2. Furthermore, the co-prescription of MART therapy and SABA suggests confusion between reliever strategies in real world.