Influence of patients' characteristics and disease management on asthma control

Background

Although asthma control is a major outcome in disease management, little is known about its determinants.

Objectives

We sought to study the relationships between asthma control and patient characteristics or asthma management.

Methods

Asthmatic patients (age 18-50 years) who were regular customers of pharmacies and had a prescription for an antiasthma medication were recruited consecutively. Patients completed a questionnaire, which was complemented by computerized pharmacy records of previously dispensed medications. Asthma control (adequate/inadequate) was assessed with the Asthma Control Test. Determinants of asthma control were identified by means of multivariate logistic regression analysis.

Results

The mean age of the 1351 patients included was 36.8 years (SD, 9.8), and 55.8% were women. A minority of patients were considered to have had their symptoms adequately controlled. Smoking, female sex, and a body mass index of greater than 30 kg/m² were all independent determinants of inadequate control. Compared with patients receiving inhaled corticosteroid monotherapy, those who were dispensed fixed combinations of inhaled corticosteroids and long-acting β-agonists presented with a significantly lower risk of inadequate asthma control (odds ratio, 0.58; 95% CI, 0.35-0.96).

Conclusion

Asthma control varied according to both the patients' characteristics and therapy.

Clinical implications

Our results strongly support the need to improve asthma control, especially in primary care and in women. A regular use of fixed controller combinations, helping patients to quit smoking, or addressing weight issues might contribute to improvement in asthma control.

Key words: Asthma, control, therapy, sex, smoking, primary care

Abbreviations used: ACT, Asthma Control Test, BMI, Body mass index, GP, General practitioner, ICS, Inhaled corticosteroid, LABA, Long-acting β₂-agonist