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PubMed2002

Inadequate use of asthma medication in the United States: results of the asthma in America national population survey.

BACKGROUND: Studies of the use of anti-inflammatory asthma therapy have been limited to selected populations or have been unable to assess the appropriateness of therapy for individuals. OBJECTIVE: We sought to describe the current use of asthma medication in the United States population and to examine the influence of symptoms and sociodemographics on medication use. METHODS: This study was based on a cross-sectional, national, random-digit-dial household telephone survey in 1998 designed to identify adult patients and parents of children with current asthma. Respondents were classified as having current asthma if they had a physician's diagnosis of asthma and were either taking medication for asthma or had asthma symptoms during the past year. RESULTS: One or more persons met the study criteria for current asthma in 3273 (7.8%) households in which a screening questionnaire was completed. Of these, 2509 persons (721 children <16 years) with current asthma were interviewed. Current use of anti-inflammatory medication was reported by 507 (20.1%). Of these, most were using inhaled corticosteroids (72.5%), with use of antileukotrienes reported by 11.4% and use of cromolyn-nedocromil reported by 18.6%. Of persons with persistent asthma symptoms in the past month, 26.2% reported current use of some form of anti-inflammatory medication. In bivariate analysis persons reporting lower income, less education, and present unemployment, as well as smokers, were significantly (P <.001) less likely to report current anti-inflammatory use than were other populations. In a multiple regression model nonsmokers and those of white, non-Hispanic ethnicity, as well as persons reporting less asthma control, were more likely to report current anti-inflammatory medication use. CONCLUSION: In the United States use of appropriate asthma therapy remains inadequate. Strategies to increase use of anti-inflammatory therapy among patients with asthma are needed. These might include methods to increase access to asthma care for minorities and the socioeconomically disadvantaged.

Adolescent↗
PubMedDate not supplied

Lung disease and asthma severity in adults with asthma: data from the Third National Health and Nutrition Examination.

Risk factors for obstructive or restrictive lung disease among persons with asthma are not well defined. Data from the Third National Health and Nutrition Examination Survey were used to determine predictors of poor lung function among 1063 adults, aged 20 years and older, who self-report physician-diagnosed asthma any time during their life regardless of current asthma status. Obstructive lung disease and restrictive lung disease were defined by using spirometry and modified Global Initiative for Chronic Obstructive Lung Disease criteria. Reported symptoms were used to grade asthma severity. Logistic regression models were used to examine associations between lung disease, respiratory symptom severity, and adults who ever had asthma. Risk factors for spirometry-defined obstructive lung disease included increasing age, body mass index < 18.5, current asthma, and non-white race (p < 0.05). Risk factors for spirometry-defined restrictive lung disease included older age at asthma diagnosis, low socioeconomic status, current asthma, and being female (p < 0.05). Risk factors for moderate or severe respiratory symptoms included older age at diagnosis and current smoking status (p < 0.05). Asthma is a known risk factor for chronic obstructive lung disease; these data also suggest that adults, particularly females, who are older at the time of asthma diagnosis, may be at risk to develop spirometry-defined restrictive lung disease as well. These data also suggest that a significant proportion of people with lifetime asthma have impaired lung function; however, it is unclear if more aggressive therapy for asthma would prevent these complications. To further examine the role of these factors in predicting poor lung function among adults with asthma, additional information is needed on these patients' asthma therapy, natural history, and environmental exposures.

Adult↗
PubMed2004

Asthma severity and asthma control: symptoms, pulmonary function, and inflammatory markers.

PURPOSE OF REVIEW: Asthma severity and asthma control are distinct yet related concepts. Asthma severity describes the underlying disease in the absence of therapy and is ideally defined without concurrent treatment confounding its assessment. Asthma control describes the clinical status of disease in the face of intervention. However, the individual parameters by which we define asthma severity and asthma control overlap significantly. A MEDLINE search between July 1, 2002, and June 30, 2003, was performed using keywords related to concepts of asthma severity of illness and asthma control. From these articles the author selected the articles most relevant for discussion. RECENT FINDINGS: Asthma is a complex syndrome. Although correlations exist between the various parameters used in clinical assessment, no single parameter can accurately classify all individuals. Assessment of multiple parameters including physiologic measures, symptoms, and activity limitation are necessary to categorize asthma clinical status accurately. In addition, the role biomarkers play in the assessment of disease status is an area of increasing interest. Several validated multidimensional measures for assessing asthma control are now available. Each of these measures includes the parameters of symptoms, activity limitation, and rescue medication use, yet they vary on inclusion of other important components such as physiologic measures and biomarkers. SUMMARY: Asthma is a complex syndrome. Currently available instruments demonstrate an improved understanding of the multidimensional approach required to assess asthma control accurately. However, debate continues on the optimal parameters to be included and the role biomarkers play in the clinical assessment of asthma.

Asthma↗
PubMed2005

Increased risk of asthma attacks and emergency visits among asthma patients with allergic rhinitis: a subgroup analysis of the investigation of montelukast as a partner agent for complementary therapy [corrected].

BACKGROUND: Inadequately controlled allergic rhinitis (AR) in asthmatic patients can contribute towards increased asthma exacerbations and poorer symptom control, which may increase medical resource use. We assessed asthma-related medical resource use and attacks in asthmatic patients who did and did not have concomitant AR and were adding montelukast or salmeterol to baseline treatment with inhaled fluticasone. METHODS: A post hoc resource use analysis of a 52-week, double-blind multicentre clinical trial (Investigation of Montelukast as a Partner Agent for Complementary Therapy) [corrected] including 1490 adults with chronic asthma, aged 15-72 years, with FEV(1) 50-90% of predicted and > or =12% increase in FEV(1) after salbutamol administration, treated with either montelukast 10 mg daily or salmeterol 50 microg twice daily in addition to fluticasone 200 microg, was undertaken. Asthma-related medical resource use included medical visits (defined as either an unscheduled visit [to a general practitioner, a specialist or a non-medical provider] or a specialist visit), emergency room visits and hospitalizations during follow-up. Asthma attacks were defined as the worsening of asthma requiring unscheduled visit, emergency visit, hospitalization or oral/intravenous/intramuscular corticosteroids. RESULTS: A self-reported history of concomitant AR was identified in 60% of the patients (n=893). Univariate analysis suggests that significantly more patients with concomitant AR experienced emergency room visits (3.6% vs. 1.7%, P=0.029) and asthma attacks (21.3% vs. 17.1%, P=0.046). Multivariate analysis adjusting for treatment group, age and baseline asthma severity confirmed these results since the presence of concomitant AR in patients with asthma increases the likelihood of emergency room visit (odds ratio (OR)=2.35, 95% confidence interval (CI)=1.12-4.80) and asthma attack (OR=1.35, 95% CI=1.03-1.77). Patients with asthma alone compared with patients with both conditions did not differ in terms of unscheduled or specialist visits and hospitalizations. CONCLUSIONS: Presence of self-reported concomitant AR in patients with asthma resulted in a higher rate of asthma attacks and more emergency room visits compared with asthma patients without concomitant AR.

Acetates↗
PubMed2004

Evaluation of the Asthma Life Quality test for the screening and severity assessment of asthma.

BACKGROUND: Asthma Life Quality (ALQ) test, a 20-question questionnaire developed by the American College of Allergy, Asthma and Immunology, has been shown to be useful for asthma diagnosis. We aimed to determine the relation between ALQ scores and (a) diagnosis of asthma; (b) physician's classification of asthma severity according to National Institutes of Health/Global Initiative for Asthma (GINA). METHODS: Standard translation and cultural adaptation to Portuguese was performed. Patients self-administered the ALQ in the waiting room; the attending allergist classified them, blindly for the test. The scores of nonasthmatics were compared with those of asthma patients. Asthma patients were analyzed in two severity groups: intermittent and mild persistent asthma (IMPA), and moderate and severe persistent asthma (MSPA); sensitivity, specificity, positive and negative predictive values were calculated and receiver operating characteristic curve plotted. Logistic regression analysis models were computed. RESULTS: From 283 patients, 237 tests were analyzed. Non-asthmatic patients ALQ scores (mean +/- SD) were 6 +/- 4 and, for asthmatics, 10 +/- 5 [mean difference 4.6 (95%CI 3.3-5.9)]. The odds of positive diagnosis increased 1.27 times (95%CI 1.17-1.38) for each one-unit increase in the test. For asthma severity ALQ scores were 9 +/- 4 for IMPA, 15 +/- 3 for MSPA [difference 6.0 (95%CI 4.8-7.1)]; with a sensitivity of 88% and specificity of 74% for a score of 12. The odds of MSPA increased 1.49 times (95%CI 1.28-1.74) per unit increase in ALQ. CONCLUSIONS: ALQ can help both to identify patients with asthma and to differentiate those more likely to have moderate/severe asthma. These are relevant characteristics for the possible use of this simple, self-administered questionnaire in the assessment of asthma patients needing additional medical management.

Adolescent↗
PubMedDate not supplied

The impact of asthma management guideline dissemination on the control of asthma in the community.

OBJECTIVE: To measure the impact of asthma management education on the control of asthma in the community. DESIGN: A cross-sectional study comparing three communities. SETTING: Three rural communities in southern Alberta. PATIENTS AND METHODS: A population sample of patients with asthma attending a pharmacy to fill a prescription for asthma medication were selected from three communities. Patients were asked to complete a questionnaire relating to their asthma management and control. INTERVENTION: Three levels of asthma management education were provided in the three communities with populations of 6000 to 10,000. The levels of education ranged from standard continuing medical education programs relating to the national asthma guidelines and a visiting asthma nurse educator to the establishment of an asthma clinic and a multiple-target, intensive education program for health professionals, town leaders, local media, schools and the public. The survey of the population with asthma was conducted approximately one year after the education program had been completed. RESULTS: A total of 327 completed questionnaires were submitted. Analysis showed that there was no significant difference that could be attributed to the intervention in the management of asthma or in the level of asthma control among the patients from the three communities. CONCLUSION: The more intense levels of education used to disseminate the content of the national asthma management guidelines did not translate into improved asthma control in the community.

Adult↗
PubMed2002

The burden of asthma in the United States: level and distribution are dependent on interpretation of the national asthma education and prevention program guidelines.

Asthma imposes a growing burden on society in terms of morbidity, quality of life, and healthcare costs. Although federally sponsored national surveys provide estimates of asthma prevalence, these surveys are not designed to characterize the burden of asthma by self-reported disease activity. We sought to characterize asthma burden in the United States. This study was based on a cross-sectional random-digit-dial household telephone survey designed to identify adult patients and parents of children with current asthma. Global asthma burden was comprised of three components: short-term symptom burden (4-week recall), long-term symptom burden (past year), and functional impact (activity limitation). Using this construct, only 10.7% of individuals were classified as having a global asthma burden consistent with mild intermittent disease, and 77.3% had moderate to severe persistent disease. These results suggest that a majority of the United States population with asthma experiences persistent rather than intermittent asthma burden. In addition, the discordance in type and distribution of asthma symptoms reported by individual subjects suggests that the exact estimate of the burden of asthma is related to how the National Asthma Education and Prevention Program classification is operationalized. Inquiry into recent day or nighttime symptoms alone underestimates the burden of asthma and may lead to inadequate treatment of asthma based on national guideline recommendations.

Adolescent↗
PubMed2000

Clinical management of asthma in 1999: the Asthma Insights and Reality in Europe (AIRE) study.

Asthma management guidelines provide recommendations for the optimum control of asthma. This survey assessed the current levels of asthma control as reported by patients, which partly reflect the extent to which guideline recommendations are implemented. Current asthma patients were identified by telephone by screening 73,880 households in seven European countries. Designated respondents were interviewed on healthcare utilization, symptom severity, activity limitations and asthma control. Current asthma patients were identified in 3,488 households, and 2,803 patients (80.4%) completed the survey. Forty-six per cent of patients reported daytime symptoms and 30% reported asthma-related sleep disturbances, at least once a week. In the past 12 months, 25% of patients reported an unscheduled urgent care visit, 10% reported one or more emergency room visits and 7% reported overnight hospitalization due to asthma. In the past 4 weeks, more patients had used prescription quick-relief medication (63%) than inhaled corticosteroids (23%). Patient perception of asthma control did not match their symptom severity; approximately 50% of patients reporting severe persistent symptoms also considered their asthma to be completely or well controlled. The current level of asthma control in Europe falls far short of the goals for long-term asthma management. Patients' perception of asthma control is different from their actual asthma control.

Adult↗
PubMed1999

A pilot study describing local residents' perceptions of asthma and knowledge of asthma care in selected Chicago communities.

STUDY OBJECTIVES: To understand inner-city Chicago residents' perception of the prevalence and severity of asthma as well as their knowledge of asthma control and management. DESIGN: Cross-sectional survey using a random digital telephone dialing method. SETTINGS: Five inner-city Chicago communities where a high prevalence and mortality of asthma have been recognized. PARTICIPANTS: All the residents in the selected communities with a residential telephone had an equal opportunity to be surveyed. MEASUREMENTS AND RESULTS: The unit of measurement was the household. Only one adult member (age 18 or older) in any randomly selected household was interviewed. The survey included questions modified from the Chicago Asthma Surveillance Initiative study. A total of 2,322 phone calls with 527 successful contacts were made over 1,938 distinct phone lines, resulting in a response rate of 175 of 527 calls (33.2%). Seventy-nine of the participants (45.1%) reported that at least one of their family members (including themselves) has asthma. Eight persons (4.6%) reported asthma as one of the top three health concerns in their community. Of the top three health reasons mentioned for children's being absent from school, only seven persons (4%) mentioned asthma. Participants were unlikely to perceive that the problems with access to asthma care and environmental triggers for asthma in their communities were any worse compared with other communities. Participants having family members with diagnosed asthma scored no better when asked general-knowledge questions about asthma or its signs and triggers than those without a family member having asthma. CONCLUSIONS: The participants' knowledge and beliefs about the seriousness of asthma revealed in this study appeared unlikely to enhance or support compliance with the challenging requirements of the National Asthma Education and Prevention Panel guidelines. The study was conducted with a small sample, and the results should be carefully interpreted.

Adult↗
PubMed2005

Risk factors for asthma and asthma severity in nonurban children in Connecticut.

STUDY OBJECTIVE: To examine asthma diagnosis, asthma severity, and the presence of established asthma risk factors in children who reside in nonurban communities. DESIGN: A cross-sectional study was conducted of 19,076 children (6 months to 18 years of age) who lived in 146 nonurban communities in the greater Hartford, CT, region and who were enrolled in a disease-management program (Easy Breathing II; Michelle Cloutier, MD; Hartford, CT) designed to improve asthma diagnosis and treatment. RESULTS: The overall frequency of physician-confirmed asthma in children seeking health care was 18%. Asthma frequency was related to low socioeconomic status (SES), non-Caucasian ethnicity, male gender, age > or = 5 years, and exposure to tobacco smoke, dust, or cockroaches in the multivariate analysis. When controlling for SES, African-American children were 1.33 times more likely (95% confidence interval [CI], 1.15 to 1.53) and Hispanic children were 1.60 times as likely (95% CI, 1.38 to 1.85) as Caucasian children to have asthma. In contrast, asthma severity was related to dust exposure, a family history of asthma, non-Caucasian ethnicity, and age < or = 4 years in the multivariate analysis. African-American children (odds ratio, 1.31; 95% CI, 1.03 to 1.67) had more severe asthma diagnosed as compared to Caucasian children. Hispanic ethnicity was not associated with an increase in asthma severity. CONCLUSION: Risk factors for asthma in nonurban children are similar to risk factors in urban children. Ethnicity is a risk factor for asthma regardless of SES. Even in nonurban environments, African-American and Hispanic children have more asthma, and African-American children have more severe disease than their Caucasian counterparts.

Adolescent↗
PubMed2006

National Asthma Education and Prevention Program severity classification as a measure of disease burden in children with acute asthma.

OBJECTIVE: To examine the association between the National Asthma Education and Prevention Program (NAEPP) severity classification and other measures of burden of disease in children with acute asthma. METHODS: We performed a cross-sectional study of 750 children <18 years of age with a physician diagnosis of asthma and treated in an emergency department (ED) for acute asthma exacerbation. Subjects were assigned to 1 of 4 levels of severity (mild intermittent, mild persistent, moderate persistent, or severe persistent). Assignments followed 3 methods: the report of symptom frequency alone (standard method); symptom frequency and reported controller-medication use (modified method); or the additive modified method in which the symptom frequency and reported controller-medication use were assigned numeric values and a score was calculated. An asthma-specific quality-of-life score was calculated by using the Integrated Therapeutics Group Child Asthma Short Form (ITG-CASF). The number of ED visits and hospital admissions for asthma over the previous 12 months was collected also. Differences between severity groups were compared with analysis of variance, and the proportion of variance explained (r2) was calculated. RESULTS: Using the standard classification method, 55% of subjects had mild intermittent asthma, 21% had mild persistent asthma, 14% had moderate persistent asthma, and 10% had severe persistent asthma. Among those classified as having mild intermittent asthma by symptoms alone, 22% were reclassified as having persistent asthma when controller medications were accounted for. With all 3 scoring methods, mean ITG-CASF scores decreased significantly with each increasing level of severity. However, the magnitude of this association was modest. There was a significant but limited association between severity level and mean number of ED visits and hospitalizations. CONCLUSION: NAEPP severity classification alone provides an incomplete picture of the burden of disease in children with asthma.

Anti-Asthmatic Agents↗
PubMed2002

Self-reported asthma symptoms in children and adults of Bangladesh: findings of the National Asthma Prevalence Study.

BACKGROUND: No population-based studies to determine the magnitude of the asthma problem have been carried out in Bangladesh. This study aimed to define the prevalence of asthma as well as to identify the risk factors of asthma in the general population of Bangladesh. METHODS: A cross-sectional study was conducted from January 1999 to August 1999 on 5642 Bangladeshi people. Data were collected from randomly selected primary sampling units of 8 municipality blocks of 4 large metropolitan cities, 12 municipality blocks of 6 district towns and 12 villages of 6 districts chosen randomly from all 64 districts of the country. Face-to-face interviews were performed with the housewives or other guardians at the household level using a structured questionnaire. RESULTS: The prevalence of asthma (wheeze in the last 12 months) was 6.9% (95% CI : 6.2-7.6). The prevalence of other asthma definitions were: ever wheeze (lifetime wheeze) 8.0% (95% CI : 7.3-8.7); perceived asthma (perception of having asthma) 7.6% (95% CI : 6.9-8.3); doctor diagnosed asthma (diagnosis of asthma by any category of doctor either qualified or unqualified) 4.4% (95% CI : 3.9-4.9). The prevalence of asthma in children (5-14 years) was higher than in adults (15-44 years) (7.3% versus 5.3%; odds ratio [OR] = 1.41, 95% CI : 1.09-1.82). Asthma in children was found to be significantly higher in households with <or=3 people than in larger households (OR = 2.20, 95% CI : 1.24-3.20). The low-income group (OR = 1.41, 95% CI : 1.04-1.92) and illiterate group (OR = 1.51, 95% CI : 1.01-2.24) were more vulnerable to asthma attacks than the high-income group and more educated people, respectively. CONCLUSIONS: Asthma in Bangladesh appears to be a substantial public health problem: an estimated 7 million people including 4 million children suffer from asthma-related symptoms.

Adolescent↗
PubMedDate not supplied

Asthma management by an inpatient asthma care team.

Recent surveillance data indicates that asthma continues to be a major health problem affecting children and African Americans disproportionately in terms of prevalence, emergency department visits, and hospitalization rates (Centers for Disease Control [CDC], 2002). Death rates due to asthma also remain higher in African Americans as compared to Caucasians. At Children's Hospital of Michigan, the Inpatient Asthma Service manages the majority of children hospitalized for asthma. An allergy/asthma specialist and a pediatric nurse trained in asthma management (asthma nurse specialist [ANS]) direct this service, which provides standardized inpatient asthma management according to current asthma care guidelines and asthma education to patients and their families before discharge, encourages referrals to the outpatient allergy/asthma clinic for further asthma management and education, and addresses other medical or social needs related to asthma care. The positive outcomes measured were a decreased length of hospital stay (LOS) by 12 hours per hospital admission and average cost savings of $300,000 annually for the hospital. Other positive outcomes included improved patient and family understanding of asthma and improved coordination of care. The asthma nurse specialists have had the benefit of further developing their pediatric asthma assessment, teaching, and communication skills.

Asthma↗
PubMed1998

Long-term reduction in asthma morbidity following an asthma self-management programme.

The adult "credit card" asthma self-management plan has been shown to be an effective and acceptable system for reducing asthma morbidity when introduced as part of a 6 month community-based asthma programme. The aim of the present study was to assess the effectiveness of the credit card plan 2 yrs after the end of the programme. Markers of asthma morbidity and use of medical services were compared during the 12 months before enrolment, and 2 yrs after completing the 6 month asthma programme. Of the 69 participants who originally enroled in the 6 month asthma programme, 58 were surveyed 2 yrs after completion of the programme. These participants showed a significant improvement in all but one of the asthma morbidity measures. The proportion waking most nights with asthma in the previous 12 months decreased from 29 to 9% (p=0.02), emergency visits to a general practitioner decreased from 43 to 16% (p=0.001), hospital emergency department visits with asthma decreased from 19 to 5% (p=0.02) and hospital admissions decreased from 17 to 5% (p=0.04). Only 24% of patients reported that they usually monitored their peak flow rate daily, but this increased to 73% during a "bad" attack of asthma. A long-term reduction in asthma morbidity and requirement for acute medical services can result following the introduction of the adult credit card asthma self-management plan. Adult patients with asthma are most likely to undertake peak flow monitoring preferentially during periods of unstable asthma, rather than routinely during periods of good control.

Adult↗
PubMed2006

Predicting episodes of poor asthma control in treated patients with asthma.

BACKGROUND: Asthma exacerbations are dangerous, expensive, and difficult to anticipate. OBJECTIVE: To characterize patients with asthma who had asthma episodes and exacerbations during 4 weeks of observation. METHODS: A total of 2032 volunteers with asthma (age, 3-64 years; 62% female subjects) were studied over two 2-week intervals after flu vaccine and placebo. Baseline data, including several asthma questionnaires, were analyzed for prediction of subsequent asthma events as recorded on diaries detailing peak flow, medication use, and health care use. RESULTS: During 28 days of diary collection, 43.2% of participants had at least 1 episode of poor asthma control. Most episodes were characterized by increased use of rescue medications or reductions in peak flow, but nearly 15% of participants had exacerbations characterized by use of systemic corticosteroids, unscheduled health care visits, or both. Episode frequency was highest in children <10 years of age. Additional risk factors were smoking, African American ethnicity, low lung function, and past history of severe asthma. The best predictors were symptom questionnaires, and a simple questionnaire concerning the preceding 2 weeks worked as well as more complex questionnaires or those reflecting longer periods. In regression analyses, questionnaire results, smoking, lung function, ethnicity, and asthma history all were associated with asthma episodes in people older than 10 years, whereas only asthma history was predictive in those <10 years. CONCLUSION: Symptom questionnaires are predictive of subsequent asthma episodes in people older than age 10 years, but not in younger people. CLINICAL IMPLICATIONS: Simple assessments may be helpful in identifying patients most at risk for future asthma episodes.

Adolescent↗
PubMed2001

Are asthma medications and management related to deaths from asthma?

There is controversy about the role of beta-agonists in asthma mortality, and the impact of asthma management plans remains unclear. We compared blood beta-agonist levels in patients dying from asthma with those in controls, and estimated the risks associated with specific classes of medication and patterns of management. We identified 89 asthma deaths and recruited 322 patients presenting to hospitals with acute asthma. A questionnaire was administered to the next of kin in 51 cases, and to 202 controls. Blood drawn from 35 cases and 229 controls was assayed for salbutamol. Smoking, drinking, and family problems were significantly more likely among the cases of asthma death than among the controls. The two groups were reasonably well matched with regard to markers of chronic asthma severity. Cases of asthma death were significantly less likely than controls to use a peak flow meter. Written action plans were associated with a 70% reduction in the risk of death. Use of nebulized bronchodilators or oral steroids was significantly more likely in cases of asthma death. Mean blood salbutamol concentrations were 2.5 times higher in cases of asthma. The use of oral steroids for an attack of asthma reduced the risk of death by 90%. More widespread adoption of written asthma management plans, with less reliance on beta-agonists and closer medical supervision, should reduce asthma mortality.

Adrenergic beta-Agonists↗
PubMed2004

Worldwide severity and control of asthma in children and adults: the global asthma insights and reality surveys.

BACKGROUND: In 1995, the Global Initiative for Asthma (GINA) guidelines recommended goals for the management of asthma, which were updated in 2002. However, there are no recent international surveys on the real management of asthma. OBJECTIVE: The Asthma Insights and Reality surveys are the first large-scale surveys aimed at determining international variations in the severity, control, and management of asthma in children and adults. METHODS: A cross-section of households in 29 countries in North America, Europe, and Asia were surveyed to identify from the general population asthmatic patients with symptoms within the last year or who were taking current asthma medication. A standard questionnaire was administered to 7786 adults, and, through a proxy, to 3153 children with asthma. Objective and subjective patient perception of asthma control and severity were assessed, including access to medical care, health care use, missed work-school, and medication use. RESULTS: Despite variations at a country level, a substantial effect of asthma on patients' lives was observed, with considerable loss of schooldays and workdays. The current level of asthma control worldwide falls far short of the goals for long-term management in international guidelines. A significant proportion of patients continue to have symptoms and lifestyle restrictions and to require emergency care. The proportion of adult asthmatic patients who were current smokers was also high. However, the use of anti-inflammatory preventative medication, even in patients with severe persistent asthma, was low, ranging from 26% in Western Europe to 9% in Japan, as was the use of objective lung function testing. The correlation between self-perceived severity of asthma and objective assessment of severity on the basis of GINA criteria was consistently poor in all areas. CONCLUSION: We conclude that there is direct evidence for suboptimal asthma control in many patients worldwide, despite the availability of effective therapies, with long-term management falling far short of the goals set in the GINA guidelines.

Adult↗
PubMed2005

Predictors of asthma-related health care utilization and quality of life among inner-city patients with asthma.

BACKGROUND: Asthma morbidity and mortality are highest among minority inner-city populations. OBJECTIVE: To identify factors associated with acute health care resource utilization and asthma-related quality of life among high-risk, minority patients with asthma. METHODS: We interviewed a prospective cohort of 198 adults hospitalized for asthma in an inner city hospital over a period of 1 year. Detailed information about sociodemographics, asthma history, access to care, asthma medications, and self-reported allergy to aeroallergens was collected at baseline. Data on resource utilization (emergency department visits and hospital admissions for asthma) and asthma-related quality of life were obtained at 6 months after discharge. Multivariate analyses were used to identify predictors of resource utilization and quality of life. RESULTS: The mean age of patients was 49.9 +/- 17.4 years, 78% were women, and 97% were nonwhite. At 6 months, 49% of patients had an emergency department visit or hospitalization. In multivariate analysis, adjusting for age, sex, medication regimen, and asthma severity, patients with a physician in charge of their asthma care had lower odds of resource utilization (odds ratio, 0.4; P=.03). Conversely, a self-reported history of cockroach allergy was associated with greater utilization (odds ratio, 2.3; P=.05). Asthma-related quality of life was worse among patients who spoke mostly Spanish or who reported allergy to cockroaches (P < .004). CONCLUSION: Lack of an established asthma care provider, language barriers, and self-reported allergy to cockroaches are associated with higher resource utilization and worse quality of life among minority, inner-city patients with asthma. Interventions targeting these factors may lead to better outcomes among these patients.

Animals↗