Observational study of adult patients with uncontrolled asthma in pneumology outpatients clinics in Slovenia

  • Stanislav Kajba Zdravstveni dom Celje
Keywords: uncontrolled asthma, adherence, comorbidities, specific triggers, severe asthma exacerbation

Abstract

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.

Downloads

Download data is not yet available.

References

Report GI. Global Strategy for Asthma Management and Prevention, 2018 [cited 2018 avg 25]. Available from: http://www.ginasthma.org/uploads/users/files/GINA_Report_2018.pdf
Price D, Fletcher M, van der Molen T. Asthma control and management in 8,000 European patients: the REcognise Asthma and LInk to Symptoms and Experience (REALISE) survey. NPJ Prim Care Respir Med. 2014 Jun;24(1):14009. https://doi.org/10.1038/npjpcrm.2014.9 PMID:24921985
Janežič A, Locatelli I, Kos M. 44th ESCP International Symposium on Clinical Pharmacy Medicines Information: Making Better Decisions : Lisbon, Portugal, 28-30 October 2015. Int J Clin Pharm. 2016 Apr;38(2):470–598. https://doi.org/10.1007/s11096-015-0240-y PMID:26739129
Chung KF, Wenzel SE, Brozek JL, Bush A, Castro M, Sterk PJ, et al. International ERS/ATS guidelines on definition, evaluation and treatment of severe asthma. Eur Respir J. 2014 Feb;43(2):343–73. https://doi.org/10.1183/09031936.00202013 PMID:24337046
Škrgat S, Triller N, Košnik M, Poplas Susič T, Petek D, Vodopivec Jamšek V, et al. Priporočila za obravnavo bolnika z astmo na primarni in specialistični pulmološki ravni v Sloveniji. Zdrav Vestn. 2016;85(11/12):693–706.
Terl M, Sedlák V, Cap P, Dvořáková R, Kašák V, Kočí T, et al. Asthma management: A new phenotype-based approach using presence of eosinophilia and allergy. Allergy. 2017 Sep;72(9):1279–87. https://doi.org/10.1111/all.13165 PMID:28328094
Taylor DR, Bateman ED, Boulet LP, Boushey HA, Busse WW, Casale TB, et al. A new perspective on concepts of asthma severity and control. Eur Respir J. 2008 Sep;32(3):545–54. https://doi.org/10.1183/09031936.00155307 PMID:18757695
Bateman ED, Boushey HA, Bousquet J, Busse WW, Clark TJ, Pauwels RA, et al.; GOAL Investigators Group. Can guideline-defined asthma control be achieved? The Gaining Optimal Asthma ControL study. Am J Respir Crit Care Med. 2004 Oct;170(8):836–44. https://doi.org/10.1164/rccm.200401-033OC PMID:15256389
Demoly P, Annunziata K, Gubba E, Adamek L. Repeated cross-sectional survey of patient-reported asthma control in Europe in the past 5 years. Eur Respir Rev. 2012 Mar;21(123):66–74. https://doi.org/10.1183/09059180.00008111 PMID:22379176
Reddel HK, Jenkins CR, Marks GB, Ware SI, Xuan W, Salome CM, et al. Optimal asthma control, starting with high doses of inhaled budesonide. Eur Respir J. 2000 Aug;16(2):226–35. https://doi.org/10.1034/j.1399-3003.2000.16b08.x PMID:10968496
Haughney J, Price D, Kaplan A, Chrystyn H, Horne R, May N, et al. Achieving asthma control in practice: understanding the reasons for poor control. Respir Med. 2008 Dec;102(12):1681–93. https://doi.org/10.1016/j.rmed.2008.08.003 PMID:18815019
Košnik M, Triller N, Šelb J. Mnenje pulmologov o pomenu vdihovalnikov pri bolnikih z astmo ali KOPB. Zdrav Vestn. 2017;86(3-4):105–14.
Adeniyl FB, Young T. Weight loss intervention for chronic asthma. Cochrane Database Syst Rev. 2012;7:CD009339.
Bousquet J, Schünemann HJ, Samolinski B, Demoly P, Baena-Cagnani CE, Bachert C, et al.; World Health Organization Collaborating Center for Asthma and Rhinitis. Allergic Rhinitis and its Impact on Asthma (ARIA): achievements in 10 years and future needs. J Allergy Clin Immunol. 2012 Nov;130(5):1049–62. https://doi.org/10.1016/j.jaci.2012.07.053 PMID:23040884
Sopo SM, Radzik D, Calvani M. Does treatment with proton pump inhibitors for gastroesophageal reflux disease (GERD) improve asthma symptoms in children with asthma and GERD? A systematic review. J Investig Allergol Clin Immunol. 2009;19:1–5. PMID:19274922
Meltzer EO, Busse WW, Wenzel SE, Belozeroff V, Weng HH, Feng J, et al. Use of the Asthma Control Questionnaire to predict future risk of asthma exacerbation. J Allergy Clin Immunol. 2011 Jan;127(1):167–72. https://doi.org/10.1016/j.jaci.2010.08.042 PMID:21093024
Loymans RJ, Honkoop PJ, Termeer EH, Snoeck-Stroband JB, Assendelft WJ, Schermer TR, et al. Identifying patients at risk for severe exacerbations of asthma: development and external validation of a multivariable prediction model. Thorax. 2016 Sep;71(9):838–46. https://doi.org/10.1136/thoraxjnl-2015-208138 PMID:27044486
Gibson PG, Powell H, Coughlan J, Wilson AJ, Abramson M, Haywood P, et al. Self-management education and regular practitioner review for adults with asthma. Cochrane Database Syst Rev. 2003;(1):CD001117. PMID:12535399
Published
2019-10-28
How to Cite
1.
Kajba S. Observational study of adult patients with uncontrolled asthma in pneumology outpatients clinics in Slovenia. TEST ZdravVestn [Internet]. 28Oct.2019 [cited 28Mar.2024];88(9-10):415-6. Available from: http://vestnik-dev.szd.si/index.php/ZdravVest/article/view/2904
Section
Original article