Demographic, Environmental and Disease Self-Management Factors Associated with Asthma Exacerbations in the U.S. According to Asthma Call Back Survey Data

Abstract

Asthma exacerbations, episodes of worsening symptoms requiring additional treatment, are a major source of asthma morbidity and healthcare costs. Disparities in exacerbations by race/ethnicity, sex, and income are known in the U.S., especially for African Americans, Puerto Ricans, women and those with low incomes. Several environmental factors, including cigarette smoke, mold, and dust mites, have been associated with asthma exacerbations. Decreasing exposure to such triggers, as well as improving disease self-management skills, are known to decrease asthma exacerbations. However, the relationship among demographic, environmental, and self-management factors in the U.S. is not fully understood. We used results from a national phone-based survey to better understand the factors that may contribute to disparities in asthma exacerbations. METHODS: Asthma Call-Back Survey (ACBS) data from 2014 and 2015 corresponding to 23,741 respondents from 32 states and Puerto Rico was obtained (https://www.cdc.gov/brfss/annual_data/annual_data.htm). Exacerbations were defined as an affirmative response to a question of "having visited the ED or urgent care because of asthma at least once in the past 12 months." Logistic regression models with exacerbations as outcome and various demographic, environmental and selfmanagement factors as predictors were created with the R Survey package, while considering survey design. RESULTS: Consistent with previous studies, female sex, black race/ethnicity, low income, and obese body mass index (BMI) were significantly associated with increased exacerbations. In terms of asthma self-management, people with exacerbations in the previous year were more likely to have had various interventions related to recognizing symptoms, having an asthma action plan, and learning what to do during an asthma attack (Table ). Most (20,443/21,499; 95%) respondents received inhaler technique guidance, which was not associated with exacerbations. Results to questions related to environmental factors found that persons with exacerbations were more likely to have been advised to change things in home, use mattress and pillow covers to control dust mites and have an air cleaner. According to unadjusted analyses, household mold and smoking inside the home were the most prominent environmental factors associated with exacerbations. CONCLUSIONS: Persons with asthma exacerbations in the prior year had increased interventions that are appropriate to decrease exacerbations, with mold and smoking in the home being the most noticeable potential triggers. Longitudinal studies are necessary to determine whether the listed self-management strategies, as well as interventions to decrease exposure to mold and smoke in the home, have a sustained impact on decreasing future exacerbations.