The correlation between asthma control and health status: the GOAL study

Abstract

The present study examined the association between guideline-derived asthma control and health-related quality of life, assessed using the Asthma Quality of Life Questionnaire (AQLQ), in patients with uncontrolled asthma whose treatment was directed towards achieving the highest possible level of control.The present randomised, double-blind, parallel-group study compared the efficacy of fluticasone propionate (FP) and salmeterol/fluticasone propionate combination (SFC) in achieving two composite, guideline-derived measures of control: total control (TC) and wellcontrolled (WC) asthma. Not achieving these levels was classed as not well-controlled (NWC). Doses were augmented until patients achieved TC or reached the maximum dose. This dose was maintained for the remainder of the study. AQLQ was assessed at baseline and at each clinic visit.AQLQ scores improved throughout the study, reaching near-maximal levels in patients achieving TC and WC, and 52-week mean scores in the three control groups were statistically significantly different. Clinically meaningful improvements (mean change from baseline) were: TC group (SFC 1.9, FP 1.8), WC (SFC 1.5, FP 1.5) and NWC (SFC 1.0, FP 0.9).In conclusion, the treatment aimed at controlling asthma improves the health-related quality of life to levels approaching normal. The difference in Asthma Quality of Life Questionnaire scores between total control and well-controlled confirms that patients distinguish even between these high levels of control.

Improvement in asthma endpoints when aiming for total control: salmeterol/fluticasone propionate versus fluticasone propionate alone

“…AQLQ scores improved throughout the study, and the overall score for all groups and strata approached the value of 6, suggesting that asthma no longer had a significant impact on quality of life. 4,10 Further analysis has revealed statistically significant differences between AQLQ scores in Totally Controlled, Well Controlled and Not Well Controlled patients, suggesting that the differences in these control definitions are perceptible to patients. 10 The differences between treatments were more pronounced in Strata 2 and 3 compared with Stratum 1.…”

“…4,10 Further analysis has revealed statistically significant differences between AQLQ scores in Totally Controlled, Well Controlled and Not Well Controlled patients, suggesting that the differences in these control definitions are perceptible to patients. 10 The differences between treatments were more pronounced in Strata 2 and 3 compared with Stratum 1. This may be due to patients in Strata 2 and 3 experiencing nearmaximal improvements from the ICS doses used prior to screening.…”

Asthma‐COPD overlap syndrome—Coexistence of chronic obstructive pulmonary disease and asthma in elderly patients and parameters for their differentiation

“…It is reported that both MDIs and DPIs are adequate for COPD, even severe COPD. Subgroup analysis of the GOAL21 and TORCH22 study results showed that the combination of fluticasone and salmeterol, which are DPIs, was effective for both asthma in elderly patients and COPD. It is important to select ICS devices for ACOS patients on the basis of the inhalation technique, device type, and patient compliance.…”

Asthma control—Practical suggestions for practicing doctors in family practice

“…6 Total control is the aim. There are a number of important conclusions that can be drawn from this study.…”