Tracing Uncontrolled Asthma in Family Practice Using a Mailed Asthma Control Questionnaire

BackgroundThe phase 3 QUEST study (NCT02414854) in patients with uncontrolled, moderate-to-severe asthma has demonstrated the efficacy and safety of dupilumab 200 and 300 mg every 2 weeks versus placebo. This post hoc analysis assessed the effect of dupilumab on efficacy outcomes and asthma control across a range of historical exacerbation rates in patients with type 2−high asthma.MethodsAnnualised severe exacerbation rates over the 52-week treatment period, pre-bronchodilator forced expiratory volume in 1 s (FEV1) at weeks 12/52, and the 5-item Asthma Control Questionnaire (ACQ-5) score at 24/52 were assessed in patients with ≥1, ≥2, or ≥3 exacerbations in the previous year. Subgroups were stratified by baseline blood eosinophils ≥150 or ≥300 cells·μL−1 or baseline fractional exhaled nitric oxide ≥25 ppb and baseline inhaled corticosteroid dose.ResultsAcross all type 2−high subgroups, dupilumab versus placebo significantly reduced severe exacerbations by 54 to 90%, with greater improvements in patients with more exacerbations prior to study initiation. Similarly, improvements in FEV1 (least squares [LS] difference versus placebo: ≥1 exacerbation, 0.15 to 0.25 L; ≥2 exacerbations, 0.12 to 0.32 L; ≥3 exacerbations, 0.09 to 0.38 L; majority p<0.05) and ACQ-5 score (LS mean difference range: ≥1 exacerbation, −0.30 to −0.57; ≥2 exacerbations, −0.29 to −0.56; ≥3 exacerbations, −0.43 to −0.61; all p<0.05) were observed, irrespective of prior exacerbation history, across all subgroups.ConclusionsDupilumab significantly reduced severe exacerbations and improved FEV1 and asthma control in patients with elevated type 2 biomarkers irrespective of exacerbation history and baseline ICS dose.

Download Full-text

Evaluation of Asthma Control by Physicians and Patients: Comparison with Current Guidelines

Canadian Respiratory Journal ◽

10.1155/2002/731804 ◽

2002 ◽

Vol 9 (6) ◽

pp. 417-423 ◽

Cited By ~ 90

Author(s):

Louis-Philippe Boulet ◽

Robert Phillips ◽

Paul O’Byrne ◽

Allan Becker

Keyword(s):

Asthma Control ◽

Airflow Obstruction ◽

Ordinal Scale ◽

Consensus Guidelines ◽

Uncontrolled Asthma ◽

Treatment Needs ◽

Night Time ◽

Asthma Control Questionnaire ◽

Current Asthma ◽

Current Guidelines

BACKGROUND:Current asthma consensus guidelines recommend a series of criteria for determining whether asthma is controlled. It is not known whether physicians are using these criteria to assess treatment needs and how effective such assessments are compared with patient assessment of asthma control.OBJECTIVE: To compare the parameters used by physicians and patients with asthma to determine whether asthma control is acceptable, according to the current Canadian asthma consensus guidelines.DATA AND METHODS: A total of 183 Canadian physicians, mostly general practitioners, evaluated 856 patients with mildly to moderately uncontrolled asthma who were not using anti-inflammatory medications at the time of entry in the study. Physician characteristics and patient demographics were obtained. The physicians completed two questionnaires, one assessing the level of asthma control of the patient on an ordinal scale from 1 (very poor) to 5 (very good) and another indicating the parameters that were used to evaluate this level of control. Patients answered an asthma control questionnaire identical to the one completed by the physician and completed a six-question asthma control questionnaire, with each question scored on a 0- to 6-point scale.RESULTS: Although according to current asthma guidelines all patients surveyed had uncontrolled asthma, 66.2% of patients and 43.3% of physicians rated control of asthma symptoms as adequate to very good. The average scores for patient- and physician-rated asthma control were 3.0±0.2 and 2.6±0.2, respectively. The average patient score on the Juniper asthma questionnaire was 12.2±6.3. Physicians used a mean of seven parameters to assess the patient’s level of asthma control, mostly beta2-agonist need, followed by cough, wheezing, shortness of breath, limitation of physical activities and night-time awakenings. Pediatricians used cough more frequently as an evaluation parameter, and respirologists measured pulmonary function more often than other physcians. Some parameters not usually included in guideline criteria for control, such as fatigue, need to clear throat, colored sputum, headache and dizziness, were sometimes used by physicians. Only 10% and 18% of physicians used measurements of forced expiratory volume in 1 s and peak expiratory flow, respectively, in asthma control assessments.CONCLUSIONS: The present study shows that the selection of asthma control criteria among physicians varies and is not always in keeping with current asthma guidelines. Both patients and physicians often consider asthma to be controlled, when according to current guidelines, it is not, and patients consider their asthma better controlled than do physicians. Objective measures of airflow obstruction are rarely used to assess asthma control. The present study stresses the need for improved dissemination - to both patients and physicians - of current recommendations on how asthma control should be determined.

Download Full-text

Is a low level of education a limiting factor for asthma control in a population with access to pulmonologists and to treatment?

Jornal Brasileiro de Pneumologia ◽

10.1590/1806-3713/e20180052 ◽

2019 ◽

Vol 45 (1) ◽

Author(s):

Cassia Caroline Emilio ◽

Cintia Fernanda Bertagni Mingotti ◽

Paula Regina Fiorin ◽

Leydiane Araujo Lima ◽

Raisa Lemos Muniz ◽

...

Keyword(s):

Risk Factor ◽

Asthma Control ◽

Treatment Adherence ◽

Limiting Factor ◽

Inhaler Technique ◽

Uncontrolled Asthma ◽

Asthma Control Questionnaire ◽

Level Of Education ◽

Low Level ◽

Asthma Symptoms

ABSTRACT Objective: To determine whether a low level of education is a risk factor for uncontrolled asthma in a population of patients who have access to pulmonologists and to treatment. Methods: This was a cross-sectional study involving outpatients > 10 years of age diagnosed with asthma who were followed by a pulmonologist for at least 3 months in the city of Jundiai, located in the state of São Paulo, Brazil. The patients completed a questionnaire specifically designed for this study, the 6-item Asthma Control Questionnaire (to assess the control of asthma symptoms), and a questionnaire designed to assess treatment adherence. Patients underwent spirometry, and patient inhaler technique was assessed. Results: 358 patients were enrolled in the study. Level of education was not considered a risk factor for uncontrolled asthma symptoms (OR = 0.99; 95% CI: 0.94-1.05), spirometry findings consistent with obstructive lung disease (OR = 1.00; 95% CI: 0.99-1.01), uncontrolled asthma (OR = 1.03; 95% CI: 0.95-1.10), or the need for moderate/high doses of inhaled medication (OR = 0.99; 95% CI: 0.94-1.06). The number of years of schooling was similar between the patients in whom treatment adherence was good and those in whom it was poor (p = 0.08), as well as between those who demonstrated proper inhaler technique and those who did not (p = 0.41). Conclusions: Among asthma patients with access to pulmonologists and to treatment, a low level of education does not appear to be a limiting factor for adequate asthma control.

Download Full-text

Changes in quantifiable breathing pattern components predict asthma control: an observational cross-sectional study

Asthma Research and Practice ◽

10.1186/s40733-021-00071-3 ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Panagiotis Sakkatos ◽

Anne Bruton ◽

Anna Barney

Keyword(s):

Asthma Control ◽

Breathing Pattern ◽

Cross Sectional Study ◽

Uncontrolled Asthma ◽

Asthma Control Questionnaire ◽

Cross Sectional ◽

Mean Values ◽

Subject Variability ◽

Asthma Patients ◽

Within Subject Variability

Abstract Background Breathing pattern disorders are frequently reported in uncontrolled asthma. At present, this is primarily assessed by questionnaires, which are subjective. Objective measures of breathing pattern components may provide additional useful information about asthma control. This study examined whether respiratory timing parameters and thoracoabdominal (TA) motion measures could predict and classify levels of asthma control. Methods One hundred twenty-two asthma patients at STEP 2- STEP 5 GINA asthma medication were enrolled. Asthma control was determined by the Asthma Control Questionnaire (ACQ7-item) and patients divided into ‘well controlled’ or ‘uncontrolled’ groups. Breathing pattern components (respiratory rate (RR), ratio of inspiration duration to expiration duration (Ti/Te), ratio of ribcage amplitude over abdominal amplitude during expiration phase (RCampe/ABampe), were measured using Structured Light Plethysmography (SLP) in a sitting position for 5-min. Breath-by-breath analysis was performed to extract mean values and within-subject variability (measured by the Coefficient of Variance (CoV%). Binary multiple logistic regression was used to test whether breathing pattern components are predictive of asthma control. A post-hoc analysis determined the discriminant accuracy of any statistically significant predictive model. Results Fifty-nine out of 122 asthma patients had an ACQ7-item < 0.75 (well-controlled asthma) with the rest being uncontrolled (n = 63). The absolute mean values of breathing pattern components did not predict asthma control (R2 = 0.09) with only mean RR being a significant predictor (p < 0.01). The CoV% of the examined breathing components did predict asthma control (R2 = 0.45) with all predictors having significant odds ratios (p < 0.01). The ROC curve showed that cut-off points > 7.40% for the COV% of the RR, > 21.66% for the CoV% of Ti/Te and > 18.78% for the CoV% of RCampe/ABampe indicated uncontrolled asthma. Conclusion The within-subject variability of timing parameters and TA motion can be used to predict asthma control. Higher breathing pattern variability was associated with uncontrolled asthma suggesting that irregular resting breathing can be an indicator of poor asthma control.

Download Full-text

Pilot randomised trial of a healthy eating behavioural intervention in uncontrolled asthma

European Respiratory Journal ◽

10.1183/13993003.00591-2015 ◽

2015 ◽

Vol 47 (1) ◽

pp. 122-132 ◽

Cited By ~ 29

Author(s):

Jun Ma ◽

Peg Strub ◽

Nan Lv ◽

Lan Xiao ◽

Carlos A. Camargo ◽

...

Keyword(s):

Asthma Control ◽

Healthy Eating ◽

Repeated Measures ◽

Randomised Trial ◽

Control Group ◽

Behavioural Intervention ◽

Life Questionnaire ◽

Uncontrolled Asthma ◽

Asthma Control Questionnaire ◽

Intention To Treat

Rigorous research on the benefit of healthy eating patterns for asthma control is lacking.We randomised 90 adults with objectively confirmed uncontrolled asthma and a low-quality diet (Dietary Approaches to Stop Hypertension (DASH) scores <6 out of 9) to a 6-month DASH behavioural intervention (n=46) or usual-care control (n=44). Intention-to-treat analyses used repeated-measures mixed models.Participants were middle-aged, 67% female and multiethnic. Compared with controls, intervention participants improved on DASH scores (mean change (95% CI) 0.6 (0, 1.1) versus −0.3 (−0.8, 0.2); difference 0.8 (0.2, 1.5)) and the primary outcome, Asthma Control Questionnaire scores (−0.2 (−0.5, 0) versus 0 (−0.3, 0.3); difference −0.2 (−0.5, 0.1)) at 6 months. The mean group differences in changes in Mini Asthma Quality of Life Questionnaire overall and subdomain scores consistently favoured the intervention over the control group: overall 0.4 (95% CI 0, 0.8), symptoms 0.5 (0, 0.9), environment 0.4 (−0.1, 1.0), emotions 0.4 (−0.2, 0.9) and activities 0.3 (0, 0.7). These differences were modest, but potentially clinical significant.The DASH behavioural intervention improved diet quality with promising clinical benefits for better asthma control and functional status among adults with uncontrolled asthma. A full-scale efficacy trial is warranted.

Download Full-text

Montelukast as Add-On Therapy to Inhaled Corticosteroids in the Management of Asthma (the SAS trial)

Canadian Respiratory Journal ◽

10.1155/2009/326043 ◽

2009 ◽

Vol 16 (suppl a) ◽

pp. 5A-10A ◽

Cited By ~ 2

Author(s):

J Mark Fitzgerald ◽

Sylvain Foucart ◽

Stephen Coyle ◽

John Sampalis ◽

Denis Haine ◽

...

Keyword(s):

Asthma Control ◽

Inhaled Corticosteroids ◽

Inhaled Corticosteroid ◽

Uncontrolled Asthma ◽

Open Label ◽

Asthma Control Questionnaire ◽

Asthmatic Patients ◽

The Mean ◽

Clinically Significant ◽

High Doses

AIM: To evaluate the effectiveness of montelukast as add-on therapy for asthmatic patients who remain uncontrolled with low, moderate or high doses of inhaled corticosteroid monotherapy.DESIGN: An eight-week, multicentre, open-label, observational study.RESULTS: Of 320 patients enrolled, 288 (90.0%) completed the study. Of patients who had uncontrolled asthma symptoms (Canadian Asthma Consensus Guidelines Update, 2003) but were controlled according to the Asthma Control Questionnaire (ACQ score of less than 1.5), 93.9% maintained asthma control at week 8. Of patients with uncontrolled asthma at baseline for both definitions, 63.5% achieved asthma control by week 8. The mean ± SD ACQ score decreased from 1.13±0.28 to 0.57±0.50 (P<0.001) for controlled patients at baseline and from 2.38±0.73 to 1.03±0.80 (P<0.001) for patients who were uncontrolled at baseline, each representing a clinically significant improvement.CONCLUSION: Montelukast add-on therapy is an effective alternative to inhaled corticosteroid monotherapy.

Download Full-text

Association between severe asthma and changes in the stomatognathic system

Jornal Brasileiro de Pneumologia ◽

10.1590/s1806-37562015000600006 ◽

2016 ◽

Vol 42 (6) ◽

pp. 423-428 ◽

Cited By ~ 4

Author(s):

Mayra Carvalho-Oliveira ◽

◽

Cristina Salles ◽

Regina Terse ◽

Argemiro D'Oliveira Júnior ◽

...

Keyword(s):

Asthma Control ◽

Severe Asthma ◽

Muscle Function ◽

Breathing Pattern ◽

Dental Arch ◽

Uncontrolled Asthma ◽

Asthma Control Questionnaire ◽

Stomatognathic System ◽

Global Initiative For Asthma ◽

Global Initiative

ABSTRACT Objective: To describe orofacial muscle function in patients with severe asthma. Methods: This was a descriptive study comparing patients with severe controlled asthma (SCA) and severe uncontrolled asthma (SUA). We selected 160 patients, who completed a sociodemographic questionnaire and the 6-item Asthma Control Questionnaire (ACQ-6), as well as undergoing evaluation of orofacial muscle function. Results: Of the 160 patients evaluated, 126 (78.8%) and 34 (21.2%) presented with SCA and SUA, respectively, as defined by the Global Initiative for Asthma criteria. Regardless of the level of asthma control, the most frequent changes found after evaluation of muscle function were difficulty in chewing, oronasal breathing pattern, below-average or poor dental arch condition, and difficulty in swallowing. When the sample was stratified by FEV1 (% of predicted), was significantly higher proportions of SUA group patients, compared with SCA group patients, showed habitual open-mouth chewing (24.8% vs. 7.7%; p < 0.02), difficulty in swallowing water (33.7% vs. 17.3%; p < 0.04), and voice problems (81.2% vs. 51.9%; p < 0.01). When the sample was stratified by ACQ-6 score, the proportion of patients showing difficulty in swallowing bread was significantly higher in the SUA group than in the SCA group (66.6% vs. 26.6%; p < 0.01). Conclusions: The prevalence of changes in the stomatognathic system appears to be high among adults with severe asthma, regardless of the level of asthma control. We found that some such changes were significantly more common in patients with SUA than in those with SCA.

Download Full-text

Quantifiable Breathing Pattern Components Can Predict Asthma Control: an Observational Cross-sectional Study

10.21203/rs.3.rs-152796/v1 ◽

2021 ◽

Author(s):

Panagiotis Sakkatos ◽

Anne Bruton ◽

Anna Barney

Keyword(s):

Asthma Control ◽

Breathing Pattern ◽

Cross Sectional Study ◽

Uncontrolled Asthma ◽

Asthma Control Questionnaire ◽

Cross Sectional ◽

Mean Values ◽

Subject Variability ◽

Asthma Patients ◽

Within Subject Variability

Abstract Background: Breathing pattern disorders are frequently reported in uncontrolled asthma. At present, this is primarily assessed by questionnaires, which are subjective. Objective measures of breathing pattern components can provide additional useful information about asthma control. This study examined whether respiratory timing parameters and thoracoabdominal (TA) motion measures could predict and classify levels of asthma control. Methods: 122 asthma patients at STEP 2- STEP 5 GINA asthma medication were enrolled. Asthma control was determined by the Asthma Control Questionnaire (ACQ7-item) and patients divided into ‘well controlled’ or ‘uncontrolled’ groups. Breathing pattern components (respiratory rate (RR), ratio of inspiration duration to expiration duration (Ti/Te), ratio of ribcage amplitude over abdominal amplitude during expiration phase (RCampe/ABampe), were measured using Structured Light Plethysmography (SLP) in a sitting position for 5-minutes. Breath-by-breath analysis was performed to extract mean values and within-subject variability (measured by the Coefficient of Variance (CoV%). Binary multiple logistic regression was used to test whether breathing pattern components are predictive of asthma control. A post-hoc analysis determined the discriminant accuracy of any statistically significant predictive model. Results: Fifty-nine out of 122 asthma patients had an ACQ7-item < 0.75 (well-controlled asthma) with the rest being uncontrolled (n= 63). The absolute mean values of breathing pattern components did not predict asthma control (R2 = 0.09) with only mean RR being a significant predictor (p < 0.01). The CoV% of the examined breathing components did predict asthma control (R2 = 0.45) with all predictors having significant odds ratios (p < 0.01). The ROC curve showed that cut-off points > 7.40% for the COV% of the RR, > 21.66% for the CoV% of Ti/Te and > 18.78% for the CoV% of RCampe/ABampe indicated uncontrolled asthma. Conclusion: The within-subject variability of timing parameters and TA motion can be used to predict asthma control. Higher breathing pattern variability was associated with uncontrolled asthma suggesting that irregular resting breathing is an indicator of poor asthma control.

Download Full-text

Montelukast as Add-On Therapy with Inhaled Corticosteroids or Inhaled Corticosteroids and Long-Acting Beta-2-Agonists in the Management of Patients Diagnosed with Asthma and Concurrent Allergic Rhinitis (The RADAR Trial)

Canadian Respiratory Journal ◽

10.1155/2009/145071 ◽

2009 ◽

Vol 16 (suppl a) ◽

pp. 17A-24A ◽

Cited By ~ 9

Author(s):

Paul K Keith ◽

Caroline Koch ◽

Michel Djandji ◽

Jacques Bouchard ◽

Eliofotisti Psaradellis ◽

...

Keyword(s):

Allergic Rhinitis ◽

Asthma Control ◽

Inhaled Corticosteroids ◽

Consensus Guidelines ◽

Uncontrolled Asthma ◽

Asthma Control Questionnaire ◽

Asthma Symptoms ◽

Beta 2 ◽

Clinically Significant ◽

Long Acting

OBJECTIVE: To evaluate the effectiveness of montelukast as add-on therapy for patients diagnosed with asthma and concurrent allergic rhinitis who remain uncontrolled while receiving inhaled corticosteroid (ICS) monotherapy or ICS/long-acting beta-2-agonist (LABA) therapy in a community practice setting.DESIGN: An eight-week, multicentre, open-label, observational study. Patients were 15 years of age or older and, while treated with an ICS or ICS/LABA, had allergic rhinitis and uncontrolled asthma symptoms by at least two criteria as per the Canadian Asthma Consensus Guidelines. The primary outcome measure was the percentage of patients with controlled asthma symptoms after eight weeks of treatment with montelukast 10 mg once daily added to ICS or ICS/LABA therapy.RESULTS: In total, 1004 patients participated in the survey phase of the study. Of these patients, 319 continued in the treatment phase and 301 (94.4%) completed the eight-week assessment. At baseline, all patients had uncontrolled asthma symptoms based on the Canadian Asthma Consensus Guidelines; at the eight-week assessment, 229 patients (76.1%) achieved asthma control. According to the Asthma Control Questionnaire (as determined by scores of 0.75 or less), 164 patients (54.7%) achieved well-controlled asthma at week 8. The mean (± SD) Asthma Control Questionnaire score decreased from 2.03±0.80 to 0.92±0.80 (P<0.001) for all patients, representing a clinically significant improvement. A statistically and clinically significant reduction in the overall Mini Rhinitis Quality of Life Questionnaire score was achieved with a decrease from 2.57±1.20 to 1.12±1.00 (–1.45±1.35; P<0.001). Patient and physician satisfaction rates with montelukast add-on therapy were also significantly increased when compared with baseline treatment.CONCLUSION: Montelukast add-on therapy is effective for managing asthma and allergic rhinitis symptoms in patients who were previously uncontrolled with ICS or ICS/LABA treatment.

Download Full-text