OBJECTIVES: Asthma treatments have a good benefit/risk ratio. Recent recommendations from international consensus have standardised asthmatic patients' management methods (Gina 2002). Compliance with these standards, however, remains low: a more global management is required. Alliance Médica and a local sickness fund (Eure Department) have launched a disease management program, including education of patients and training of doctors to improve the state of health of patients suffering from asthma and reduce costs to the community. METHODS: The assessment is based on a "before-after" study (respectively 18 and 12 months). Two outcomes were assessed: control of the asthma and the quarterly cost of follow-up. The definition of control is based on the six criteria and thresholds from the Canadian asthma consensus report (1) . The quarterly cost is the sum of medical expenditure and production losses for patients who had at least one follow-up consultation during each period considered. RESULTS: Forty-three doctors agreed to take part in the study, 32 of whom returned the medical information electronically. Three hundred and thirty eight patients were pre-included: 27 patients did not meet the inclusion criteria and 311 subjects were eligible. Proportion of asthmatic patients controlled over the 1year period before the intervention was equal to 52.6% of the patients followed. After the intervention the control rate reached 67.7%. The incremental effectiveness is equal to 15%. After intervention, the standard quarterly costs were lower for both groups control and non-control: respectively €118.9 vs €152.7 and €359.9 vs €264.8. The overall rate of quarterly savings after intervention compared to the situation without intervention is equal to 32.4% (€172.1 versus €255.2). CONCLUSION: The "pragmatic" evaluation of the management of asthma in primary care with "trickle" inclusions and follow-ups requires a new statistical approach. This 1st primary network in France is a successful experiment. (1) CMAJ. Nov 30, 1999; 161 (11 suppl)