Phenotypic determinants of uncontrolled asthma

Received 5 January 2009; received in revised form 11 May 2009; accepted 1 June 2009. published online 10 August 2009.

Background

Although uncontrolled asthma remains frequent, determinants of asthma control are poorly studied.

Objectives

The aim was to estimate the distribution and the phenotypic characteristics of asthma control in 2 groups of subjects defined by the use of inhaled corticosteroids (ICS) in the past 12 months, in the Epidemiological study on the Genetics and Environment of Asthma, bronchial hyperresponsiveness and atopy (EGEA).

Methods

Five hundred one adult current patients with asthma who participated in the follow-up of the EGEA study were included. Asthma control was assessed from survey questions reflecting asthma control, as defined in the 2006 Global Initiative for Asthma guidelines. The factors analyzed were age, sex, educational level, body mass index, active and passive smoking, sensitization to aeroallergens, total IgE, rhinitis, chronic cough/phlegm, and age at asthma onset. Analyses were stratified according to ICS use.

Results

Uncontrolled asthma was more frequent in ICS users (27.6%, 35.0%, and 37.4% with controlled, partly-controlled, and uncontrolled asthma respectively) compared with non-ICS users (60.0%, 23.9%, and 16.1%, respectively). In ICS users, chronic cough or phlegm and female sex were independently and significantly related to uncontrolled asthma. In non-ICS users, high total IgE and sensitization to molds were associated with uncontrolled asthma. Smoking and rhinitis were not associated with asthma control.

Conclusion

Optimal asthma control remained unachieved in the majority of patients with asthma in this study. Factors associated with uncontrolled asthma were different in ICS users (chronic cough/phlegm, female sex) and non-ICS users (high total IgE and sensitization to molds).

Key words: Asthma control, risk factor

Abbreviations used: BMI, Body mass index, ECRHS, European Community Respiratory Health Survey, EGEA, Epidemiological study on the Genetics and Environment of Asthma, bronchial hyperresponsiveness and atopy, GINA, Global Initiative for Asthma, ICS, Inhaled corticosteroid, OR, Odds ratio

a INSERM, Institut National de la Santé et de la Recherche Médicale, U823, Institut Albert Bonniot, Grenoble, France

b Université Joseph Fourier, Grenoble, France

c CHU Centre Hospitalier Universitaire, Montpellier, France

d INSERM, Institut National de la Santé et de la Recherche Médicale, U780, Villejuif, France

e CIC, Centre d'Investigation Clinique, Necker, Paris, France

f INSERM, Institut National de la Santé et de la Recherche Médicale CIC3, Grenoble, France

g Clinique de Pneumology, CHU, Grenoble, France

h CHU, Lyon, France

i Hopital Trousseau, Paris, France

j Univ Paris-Sud, IFR69, Villejuif, France

k CIC, Marseille, France

l Institut National de la Santé et de la Recherche Médicale U884, Grenoble, France

m Hopital Necker, Paris, France

n Université Paris Descartes, Paris, France

o Pédiatrie, CHU, Grenoble, France

Reprint requests: Valérie Siroux, Centre de Recherche INSERM/UJF U823, Institut Albert Bonniot, BP 170, 38042 Grenoble Cedex 9, France.

Supported by grants from Merck Sharp & Dohme (MSD); Hospital program of clinical research (PHRC)-Paris; National Research Agency - Health environment, health-work program; National Research Agency (ANR)- Biological collections for health program; French Agency of health safety, environment and work (AFSSET) and the Isere committee against respiratory diseases (COMARES).

Disclosure of potential conflict of interest: C. Pison has served as a consultant for GlaxoSmithKline, Boehringer Ingelheim France, AstraZeneca, Nutricia, Numico, and Actéllion and has received research support from AB Science. The rest of the authors have declared that they have no conflict of interest.

PII: S0091-6749(09)00879-3

doi:10.1016/j.jaci.2009.06.010

19 of 57