Observational study of adult patients with uncontrolled asthma in pneumology outpatients clinics in Slovenia
Background: Almost 50 % of patients in clinical practice still have poor control of their asthma despite treatment according to the GINA (Global Initiative for Asthma) criteria. The most common causes of uncontrolled asthma are: poor inhaler technique, poor medication adherence, incorrect diagnosis, comorbidities (rhinosinusitis, GERD (Gastroesophageal Reflux Disease), obesity, depression, obstructive sleep apnea) and ongoing exposure to specific triggers (allergens, drugs and smoking).
Methods: Observational study was conducted on 323 adult patients with uncontrolled asthma in 14 outpatient pulmonology practices in Slovenia in the period from December 2017 to April 2018. Data about common causes of uncontrolled asthma and exacerbations in the last year were entered in electronic case report forms at the investigator`s site.
Results: The most common factors associated with uncontrolled asthma were comorbidities in 70 % (obesity 33 %, rhinosinusitis 28 %, GERD 22 %), specific triggers in 56 % (ongoing exposure to allergens 39 %, drugs 35 %, smoking 10 %) and poor medication adherence in 53 %. Thirty percent of patients had one or more severe exacerbations in the last year. Patient’s non-understanding of the role of asthma medications (95 % IZ: [1.4; 4.8]; p = 0.019) and the lack of self-management plan (95 % IZ: [1.3; 4.3]; p = 0.042) were the most important factors in the logistic regression model for severe exacerbations. 23 % of included patients had severe asthma according to the GINA criteria.
Conclusion: Obesity, specific triggers and poor medication adherence are the most important factors for uncontrolled asthma in the adult patient sample with uncontrolled asthma in pneumology outpatient clinics in Slovenia. Severe exacerbations are still present in these patients. Therefore, better education and providing all asthma patients with written self-management plan would be warranted in the future.
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