Key factors associated with uncontrolled asthma – the Asthma Control in Latin America Study

Abstract

Objective: This study aimed to estimate asthma control at specialist treatment centers in four Latin American countries and assess factors influencing poor asthma control. Methods: Patients aged !12 years with an asthma diagnosis and asthma medication prescription, followed at outpatient specialist centers in Argentina, Chile, Colombia, and Mexico, were included. The study received all applicable ethical approvals. The Asthma Control Test (ACT) was used to classify patients as having controlled (ACT 20-25) or uncontrolled (ACT 19) asthma. Frequency and statistical tests were used to assess the association between hospital admissions/exacerbations/emergency department (ED) visits and uncontrolled asthma; multivariate logistic regression was used to assess the association of uncontrolled asthma with clinical/demographic variables. Results: A total of 594 patients were included. Overall controlled-asthma prevalence was 43.4% (95% confidence interval [CI]: 39.0, 47.4). Patients with uncontrolled asthma were more likely to be women (adjusted odds ratio [aOR]: 1.85; p ¼ 0.003), non-white (aOR: 2.14; p < 0.001), obese (aOR: 1.71; p ¼ 0.036), to have a low monthly family income (aOR: 1.75; p ¼ 0.004), to have severe asthma (aOR:1.59; p ¼ 0.26), and, compared with patients with controlled asthma, to have a higher likelihood of asthma exacerbations (34.5% vs. 15.9%; p < 0.001), hospital admissions (6.9% vs. 3.1%; p ¼ 0.042), and ED visits (34.5% vs. 15.9%; p < 0.001) due to asthma. Conclusions: Even in specialist ambulatory services, fewer than half of patients were classified as having controlled asthma. The proportion of uncontrolled patients varied according to clinical and demographic variables.

Predicting admissions for adult asthma exacerbations in North Texas

“…Negative coefficients for median family income and percent of older housing indicate that residents in lower income or older census blocks experience greater numbers of asthma admissions than other people holding other variables constant. This is consistent with recent studies in the U.S. and abroad that continue to highlight problems with asthma management among socioeconomically stressed patients (Bryant‐Stephens et al, ; Neffen et al, ). Coefficients for average speed on road segments and road density suggest that greater levels of traffic in the census block group predict greater use of hospital and ED services for asthma exacerbations holding other variables constant.…”

“…Data regarding sex shows that adult males are less likely than adult females to be admitted for a primary diagnosis of asthma holding other variables constant. The positive relationship between adult women and asthma incidence or prevalence has been consistently documented for many years and in various countries (Habib, Javer, & Buxton, ; Jeebhay, Ngajilo, & le Mousal, ; Neffen et al, ). This relationship contrasts with the development of asthma in children where males are more often affected than females.…”

Obesity Does Not Increase the Risk of Asthma Readmissions

“…In our population of asthmatics who required any hospital readmission, more than 71% were obese or overweight, but this is not associated with the incidence of hospital readmissions. Our results are in agreement with the other authors who did not observe a relationship between obesity and exacerbations or with the control of the asthma [8,16,21,[29][30][31], although it was different from other studies where we showed a poorer control of asthma or increase in the incidence of the exacerbations with obesity [13][14][15]19,20,[32][33][34][35][36].…”

“…Similarly, they don´t have more frequent readmissions during the follow-up period. In the literature, asthma exacerbations requiring hospital admission are usually a minority, since most patients are discharged from the Emergency Room [14,65].…”

“…On analysing the prevalence of asthma, some authors showed that obesity was associated with significant increases in its prevalence [7][8][9], whilst others mentioned that obesity did not affect asthma [10,11], and in other cases that it may be associated with prevalence in some age groups, but not in others [12]. Regarding the control of the disease, it is still under debate, with some authors observing a poorer control in the obese population [13][14][15], whilst in other publications, the increase in weight does not appear to have an influence on the control of asthma [8,16,17]. On analysing the impact of obesity on the incidence of exacerbations, there are still discrepancies between authors.…”