Asthma control: where do we fail?

Kips, Johan; Pauwels, Romain

doi:10.1183/09031936.00.16579700

Cited by 30 publications

(23 citation statements)

References 24 publications

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“…The second seems to relate to physicians9 practices, as assessed by the fact that physicians who provide their patients with a written asthma management plan or peak flow meters, and hence are probably more knowledgeable about current treatment concepts, are more likely to prescribe their patients inhaled steroids. Both factors are in line with the recent observations of others [33][34][35].…”

Section: Discussionsupporting

confidence: 81%

The management of childhood asthma in the community

Maziak¹,

Mutius²,

Beimfohr³

et al. 2002

Eur Respir J

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The aim of the present study was to assess the management of children with asthma in the community.Community-based random samples of children aged 5-7 and 9-11 yrs in Dresden and Munich, Germany, were studied in 1995-1996 using the phase II protocol of the International Study of Asthma and Allergies in Childhood. Detailed information on the use of antiasthma drugs and accessory treatment in the past year was collected by parental questionnaire. A total of 11,094 (response rate 83%) children participated.Among children with wheeze in the last year, 36% had used bronchodilators and 19% were on regular anti-inflammatory treatment. The strongest determinant of treatment was a physician9s diagnosis of asthma. Forty-seven per cent of the children with current wheeze had not been diagnosed as asthmatics and received hardly any treatment (9% bronchodilators and 2% anti-inflammatory drugs), despite an increased prevalence of severe asthma symptoms, bronchial hyperresponsiveness and atopic sensitisation compared with children without asthma symptoms. The proportion of children regularly using inhaled steroids was small (6%) among current wheezers and reached only 21% among children with diagnosed asthma and w12 wheezing attacks in the last year. Inhaled steroid use was lower in Munich than in Dresden and inversely related to the use of alternative remedies.Further efforts to improve the diagnosis and treatment of childhood asthma are needed. These should aim to increase awareness of the chronic nature of asthma and the need for treatment according to current guidelines.

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Section: Discussionsupporting

confidence: 81%

The management of childhood asthma in the community

Maziak¹,

Mutius²,

Beimfohr³

et al. 2002

Eur Respir J

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“…These patients, who do not recognize or do not perceive the severity of symptoms are the ones who present greater risks of exacerbations (8) and death by asthma. (9,10) In this sense, it is important to offer physicians and patients (11,12) simple, rapid and lowcost instruments to precisely assess asthma control, both in outpatient clinics as in primary health care, (13) allowing treatment adjustments whenever necessary.…”

Section: Introductionmentioning

confidence: 99%

Avaliação do questionário de controle da asma validado para uso no Brasil

Leite¹,

Ponte²,

Petroni

et al. 2008

J. bras. pneumol.

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Objective: To evaluate whether the Portuguese version of the Asthma Control Questionnaire (ACQ) is a valid instrument to measure asthma control in adult outpatients in Brazil. Methods: We selected 278 outpatients diagnosed with asthma. All of the patients completed the questionnaire, underwent spirometry and were clinically evaluated by a physician in order to characterize the control of the disease in the first visit. The questionnaire was evaluated in three versions, with 5, 6 and 7 questions, respectively, and scores of 0.75 and 1.50 were used as cut-off points. Results: Of the 278 patients, 77 (27.7%) had intermittent asthma, 39 (14.0%) had mild persistent asthma, 40 (14.4%) had moderate persistent asthma and 122 (43.9%) had severe persistent asthma. The sensitivity of ACQ to identify uncontrolled asthma ranged from 77% to 99%, and the specificity ranged from 36% to 84%. The positive predictive value ranged from 73% to 90%, and the negative predictive value ranged from 67% to 95%. The positive likelihood ratio ranged from 1.55 to 4.81, and the negative likelihood ratio ranged from 0.03 to 0.27. In the 5-and 6-question versions of the ACQ, the intraclass correlation coefficient was 0.92. These two versions were both responsive to clinical changes in the patients. Conclusions: All three versions of the ACQ satisfactorily discriminated between patients with uncontrolled asthma and those with controlled asthma. The 5-and 6-question versions also presented good reliability and responsiveness. Therefore, the ACQ is a valid tool for evaluating asthma control in adult outpatients in Brazil.Keywords: Asthma; Therapeutics; Diagnosis; Questionnaires; Reproducibility of results. ResumoObjetivo: Avaliar se a versão em língua portuguesa do Asthma Control Questionnaire (ACQ, Questionário de Controle da Asma) é um instrumento válido para medir o controle da asma em pacientes adultos ambulatoriais no Brasil. Métodos: Foram avaliados 278 pacientes ambulatoriais com diagnóstico de asma. Todos os pacientes, durante a primeira visita, responderam ao questionário, foram submetidos à espirometria e avaliados clinicamente por um médico para a caracterização do controle da doença. Foram analisadas as versões do questionário com 5, 6 e 7 questões, utilizando dois escores distintos (0,75 e 1,50) como pontos de corte. Resultados: Dos 278 pacientes, 77 (27,7%) tinham asma intermitente, 39 (14,0%) asma persistente leve, 40 (14,4%) asma persistente moderada e 122 (43,9%) asma persistente grave. A sensibilidade do questionário para identificar asma não-controlada variou de 77% a 99% e a especificidade variou de 36% a 84%. O valor preditivo positivo variou de 73% a 90%, e o valor preditivo negativo variou de 67% a 95%. A razão de verossimilhança positiva variou de 1,55 a 4,81, e a razão de verossimilhança negativa variou de 0,03 a 0,27. Nas versões do ACQ com 5 e 6 questões, o coeficiente de correlação intraclasse foi de 0,92, e estas versões foram responsivas a mudanças no quadro clínico dos pacientes. Conclusões: O ACQ, nas suas t...

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“…We read with interest the article by RABE et al [1] and the editorial by KIPS and PAUWELS [2] in which the current level of asthma control in Europe, which has fallen far short of the goals for long term asthma management, was discussed.…”

Section: To the Editormentioning

confidence: 98%