Determinants of uncontrolled asthma in a Swedish asthma population: cross-sectional observational study

Abstract

BackgroundAsthma control is achieved in a low proportion of patients. The primary aim was to evaluate risk factors for uncontrolled asthma. The secondary aim was to assess quality of life associated with asthma control.MethodsIn a cross-sectional study, asthma patients aged 18–75 were randomly selected from primary and secondary health care centers. Postal questionnaires were sent to 1,675 patients and the response rate was 71%. A total of 846 patients from primary and 341 patients from secondary care were evaluated. Data were collected using a questionnaire and review of medical records. The questionnaire included questions about asthma control and a quality-of-life questionnaire, the mini-AQLQ, with four domains (symptoms, activity limitation, emotional function, and environmental stimuli). The mean score for each domain and the overall score were calculated. Asthma control was divided into three levels according to the GINA guidelines and partly and uncontrolled asthma were combined into one group – poorly controlled asthma.ResultsAsthma control was achieved in 36% of the sample: 38% in primary and 29% in secondary care. In primary and secondary care, 35 and 45% had uncontrolled asthma, respectively. Risk factors for poorly controlled asthma were female sex [OR 1.31 (1.003–1.70)], older age [OR 2.18 (1.28–3.73)], lower educational level [OR 1.63 (1.14–2.33)], and current smoking [OR 1.68 (1.16–2.43)]. Older age and lower educational level remained statistically significantly associated with poorly controlled asthma when the analyses were limited to never-smokers. Depression was an independent risk factor for poorly controlled asthma in men [OR 3.44 (1.12–10.54)]. The mini-AQLQ scores and the mean overall score were significantly lower in uncontrolled asthma.ConclusionRisk factors for poorly controlled asthma were female sex, older age, low educational level, and smoking. Uncontrolled asthma was significantly associated with lower quality of life.

Symptom control among asthmatics with a clinically significant smoking history: a cross-sectional study in Finland

“…We found that uncontrolled patients were current smokers more often than well/partly controlled patients (61.9% vs 39.0%; p = 0.009). The finding that current smoking is associated with worse asthma control has also been found by others [6,8] and may reflect the fact that cigarette smoke is known to reduce the response to ICS in asthmatic patients [15,16]. Furthermore, there is good evidence that asthma outcome improves in several ways after smoking cessation [3,5], which is also in line with our observation that ex-smokers had their asthma better controlled than current smokers.…”

“…It has been shown that, smoking, especially currently but also previously, is associated with poorer asthma control levels [6][7][8][9]. However, surprisingly little is known about asthma symptom control among asthmatics who smoke.…”

Symptom control among asthmatics with a clinically significant smoking history: a cross-sectional study in Finland

“…We found that uncontrolled patients were current smokers more often than well/partly controlled patients (61.9% vs 39.0%; p=0.009). The finding that current smoking is associated with worse asthma control has also been found by others (6,8) and may reflect the fact that cigarette smoke is known to reduce the response to ICS in asthmatic patients (15,16). Furthermore, there is good evidence that asthma outcome improves in several ways after smoking cessation (3,5), which is also in line with our observation that ex-smokers had their asthma better controlled than current smokers.…”

Asthma control in children is associated with nasal symptoms, obesity, and health insurance: a nationwide survey

“…Physician assessment cannot be included in this type of study. Yet, we used an internationally recommended measure for asthma control – the GINA guidelines – which are frequently used in epidemiological studies with similar methodology . Also, parents’ recall of doctor's diagnosis, for example, rhinitis, may lead to underestimation of concomitant diseases.…”