Real-world Evaluation of Asthma Control and Treatment (REACT): Findings from a national Web-based survey
Received 1 September 2006; received in revised form 20 March 2007; accepted 22 March 2007. published online 04 May 2007.
Background
Despite health initiatives for advancing the management of asthma, evidence suggests that many asthmatic subjects have uncontrolled disease. However, the prevalence of uncontrolled asthma in the United States is not known and has not been fully characterized.
Objective
We sought to assess the prevalence, morbidity, and factors associated with uncontrolled asthma in a nationally representative sample of patients with moderate-to-severe asthma using standard asthma medications.
Methods
A Web-based survey was administered to patients with diagnoses of asthma for at least 1 year who were receiving multiple controller medications. The Asthma Control Test score was used to stratify respondents into controlled and uncontrolled cohorts.
Results
A total of 1812 patients were assessed; 809 (45%) had controlled asthma, and 1003 (55%) had uncontrolled asthma. Most patients had health care coverage and received care from a general practitioner; a large proportion of patients with controlled asthma (74%) and patients with uncontrolled asthma (65%) reported never receiving an asthma action plan. Inhaled corticosteroid plus long-acting β-agonist was the most common medication regimen in patients with controlled asthma (60%) and patients with uncontrolled asthma (48%) patients. Patients with uncontrolled asthma reported significantly higher rates of health care use. Several comorbidities were predictive of uncontrolled asthma.
Conclusion
Uncontrolled asthma is highly prevalent (55%) in patients using standard asthma medications. There is need for improved asthma care in patients with moderate-to-severe asthma, including a global evaluation of asthma control, implementation of treatment plans and asthma control tests, and addressing comorbid conditions.
Clinical implications
Improved asthma care requires broader assessments of asthma control, including asthma-related health care and medication use, comorbidities, and the implementation of treatment plans and formal asthma control tests.
Winston-Salem, NC, Los Angeles, South San Francisco, and San Francisco, Calif, and Boston, Mass
aFrom the Center for Human Genomics and the Department of Internal Medicine, Section on Pulmonary, Critical Care, Allergy and Immunologic Diseases, Wake Forest University School of Medicine, Winston-Salem
bDivision of Allergy and Immunology, Department of Pediatrics, Los Angeles County and University of Southern California Medical Center, Los Angeles
eChanning Laboratory, Center for Genetics and Genomics, Brigham & Women's Hospital, Harvard Medical School, Boston
Reprint requests: Stephen P. Peters, MD, PhD, Center for Human Genomics and Department of Internal Medicine, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157.
Supported by Genentech, Inc, South San Francisco, Calif.
Disclosure of potential conflict of interest: S. P. Peters has consulting arrangements with and is on the speakers' bureau for Genentech and Novartis. C. A. Jones has consulting arrangements with Genentech, Merck, Sanofi-Aventis, and AstraZeneca; has received grant support from Genentech and Merck; and is on the speakers' bureau for Genentech, Merck, Sanofi-Aventis, and AstraZeneca. T. Haselkorn has consulting arrangements with Genentech. D. R. Mink is employed by Ovation Research Group, which receives grant support from Genentech. D. J. Valacer owns stock in Genentech and General Electric and is employed by Genentech. S. T. Weiss has consulting arrangements with Glaxo-Wellcome, Roche Pharmaceuticals, Millennium Pharmaceuticals, Genentech, Schering-Plough, Variageics, Genome Therapeutics, and Merck Frost and has received grant support from Glaxo-Wellcome, AstraZeneca, and Pfizer.
ABSTRACT