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

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.

Obstructive sleep apnea is a determinant of asthma control independent of smoking, reflux, and rhinitis

2021 ◽  
Vol 42 (1) ◽  
pp. e25-e29
Author(s):  
Dilber Özden Mat ◽  
Selma Firat ◽  
Kurtuluş Aksu ◽  
Funda Aksu ◽  
Sezgi Şahin Duyar
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Asthma Control ◽  
Inhaler Technique ◽  
Uncontrolled Asthma ◽  
Asthma Control Test ◽  
Asthma Symptoms ◽  
Obstructive Sleep ◽  
Control Asthma ◽  
Correct Technique

Background: Asthma control is defined as to what extent manifestations of asthma can be observed in a patient or have been reduced or removed by treatment. Regular use of asthma treatments, correct inhaler technique, adequate information provided about the patient's diseases and medicines, and patient‐clinician collaboration aid asthma control. Asthma shares risk factors and links in the pathogenesis with obstructive sleep apnea (OSA), and OSA may aggravate asthma symptoms. Objective: To assess the risk of OSA for asthma control. Methods: The study was carried out in subjects with asthma who were followed up at specific time points and who used asthma medication regularly and with an appropriate inhaler technique. An asthma control test and a questionnaire were used to determine the asthma control levels and OSA risk of the subjects. Results: With regard to the questionnaire scoring, 77 of 137 subjects with asthma had a low OSA risk and 60 had a high OSA risk. The proportion of the subjects with a high OSA risk (p < 0.001) and were smokers (p = 0.020) were significantly higher in the subjects with uncontrolled asthma than in those with controlled asthma. Logistic regression analysis showed that the variables that affect asthma control status were the risk of OSA and obesity. The subjects with a low OSA risk were more likely to have controlled asthma than those with a high OSA risk (odds ratio 7.896 [95% confidence interval, 2.902‐21.487]; p < 0.001). Conclusion: In the subjects with asthma and who adhered to therapy and used inhalers with the correct technique, a high risk of OSA was associated with poor control of their asthma. This association was independent of other factors, including rhinitis, gastroesophageal reflux, and smoking.

scholarly journals 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)

2009 ◽  
Vol 16 (suppl a) ◽  
pp. 17A-24A ◽  
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.

scholarly journals Can the Asthma Control Questionnaire be used to differentiate between patients with controlled and uncontrolled asthma symptoms? A pilot study

2006 ◽  
Vol 23 (6) ◽  
pp. 674-681 ◽  
Author(s):  
L. v. d. Nieuwenhof ◽  
T. Schermer ◽  
P. Eysink ◽  
E. Halet ◽  
C. van Weel ◽  
...  
Keyword(s):  
Pilot Study ◽  
Asthma Control ◽  
Uncontrolled Asthma ◽  
Asthma Control Questionnaire ◽  
Asthma Symptoms

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

2009 ◽  
Vol 16 (suppl a) ◽  
pp. 17A-24A ◽  
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.

scholarly journals Factors related to the incorrect use of inhalers by asthma patients

2014 ◽  
Vol 40 (1) ◽  
pp. 13-20 ◽  
Author(s):  
Paulo de Tarso Roth Dalcin ◽  
Denis Maltz Grutcki ◽  
Paola Paganella Laporte ◽  
Paula Borges de Lima ◽  
Samuel Millan Menegotto ◽  
...  
Keyword(s):  
Asthma Control ◽  
Family Income ◽  
Pulmonary Function Tests ◽  
Cross Sectional Study ◽  
Inhaler Technique ◽  
Metered Dose Inhalers ◽  
Porto Alegre ◽  
Asthma Control Questionnaire ◽  
Cross Sectional ◽  
Metered Dose

OBJECTIVE: To evaluate inhaler technique in outpatients with asthma and to determine associations between the correctness of that technique and the level of asthma control. METHODS: This was a cross-sectional study involving patients > 14 years of age with physician-diagnosed asthma. The patients were recruited from the Asthma Outpatient Clinic of the Hospital de Clínicas de Porto Alegre, in the city of Porto Alegre, Brazil. The patients completed two questionnaires (a general questionnaire and an asthma control questionnaire based on the 2011 Global Initiative for Asthma guidelines), demonstrated their inhaler technique, and performed pulmonary function tests. Incorrect inhaler technique was defined as the incorrect execution of at least two of the predefined steps. RESULTS: We included 268 patients. Of those, 81 (30.2%) showed incorrect inhaler technique, which was associated with poor asthma control (p = 0.002). Logistic regression analysis identified the following factors associated with incorrect inhaler technique: being widowed (OR = 5.01; 95% CI, 1.74-14.41; p = 0.003); using metered dose inhalers (OR = 1.58; 95% CI, 1.35-1.85; p < 0.001); having a monthly family income < 3 times the minimum wage (OR = 2.67; 95% CI, 1.35-1.85; p = 0.008), and having > 2 comorbidities (OR = 3.80; 95% CI, 1.03-14.02; p = 0.045). CONCLUSIONS: In the sample studied, incorrect inhaler technique was associated with poor asthma control. Widowhood, use of metered dose inhalers, low socioeconomic level, and the presence of > 2 comorbidities were associated with incorrect inhaler technique.

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

2008 ◽  
Vol 6 (suppl_1) ◽  
pp. S16-S22 ◽  
Author(s):  
L. van den Nieuwenhof ◽  
T. Schermer ◽  
M. Heins ◽  
J. Grootens ◽  
P. Eysink ◽  
...  
Keyword(s):  
Asthma Control ◽  
Family Practice ◽  
Uncontrolled Asthma ◽  
Asthma Control Questionnaire

scholarly journals Allergic Comorbidity Is a Risk Factor for Not Attending Scheduled Outpatient Visits in Children with Asthma

Children ◽  
2021 ◽  
Vol 8 (12) ◽  
pp. 1193
Author(s):  
Kalle Garpvall ◽  
Marie Hauerslev ◽  
Mads Marckmann ◽  
Mette N. Hermansen ◽  
Kirsten S. Hansen ◽  
...  
Keyword(s):  
Risk Factor ◽  
Asthma Control ◽  
Treatment Adherence ◽  
Allergic Sensitization ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Asthma Severity ◽  
Outpatient Visits ◽  
Increased Risk ◽  
Children With Asthma

Asthma is one of the most common chronic diseases in children globally. Previous studies have shown that not attending asthma primary care consultations is associated with poorer treatment adherence and increased risk of loss of asthma control on a short-term basis. Here, we investigated long-term patterns and predictors of not attending scheduled asthma outpatient visits during 5-years of follow-up in 146 children with asthma. Of the 146 children, 67 (46%) did not attend at least one scheduled appointment, amounting to a total of 122 (10.8%) missed of 1133 scheduled appointments. In a multivariate analysis adjusting for total scheduled visits in the 5-year period any allergic sensitization was a significant risk factor for not attending ≥1 scheduled appointment (aOR = 6.6 (95% CI, 1.3–39.7), p = 0.03), which was not the case for asthma treatment step or lung function. Furthermore, atopic predisposition decreased the risk of non-attendance (aOR = 0.36 (0.13–0.92), p = 0.04). We found no association between non-attendance, treatment adherence or loss of asthma control. This study highlights that allergic comorbidity, but not degree of asthma severity, identifies a group of children with asthma who are prone to not attend scheduled outpatient appointments.

scholarly journals Effect of exacerbation history on clinical response to dupilumab in moderate-severe uncontrolled asthma

2021 ◽  
pp. 2004498
Author(s):  
Jonathan Corren ◽  
Constance H. Katelaris ◽  
Mario Castro ◽  
Jorge F. Maspero ◽  
Linda B. Ford ◽  
...  
Keyword(s):  
Asthma Control ◽  
Forced Expiratory Volume ◽  
Severe Exacerbation ◽  
Uncontrolled Asthma ◽  
Phase 3 ◽  
Asthma Control Questionnaire ◽  
Elevated Type ◽  
Post Hoc ◽  
Blood Eosinophils

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.

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

2002 ◽  
Vol 9 (6) ◽  
pp. 417-423 ◽  
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.

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