Assignment

Abstract

Although uncontrolled asthma remains frequent, determinants of asthma control are poorly studied. The aim was to estimate the distribution and the phenotypic characteristics of asthma control in 2 groups of subjects defined by the use of inhaled corticosteroids (ICS) in the past 12 months, in the Epidemiological study on the Genetics and Environment of Asthma, bronchial hyperresponsiveness and atopy (EGEA). Five hundred one adult current patients with asthma who participated in the follow-up of the EGEA study were included. Asthma control was assessed from survey questions reflecting asthma control, as defined in the 2006 Global Initiative for Asthma guidelines. The factors analyzed were age, sex, educational level, body mass index, active and passive smoking, sensitization to aeroallergens, total IgE, rhinitis, chronic cough/phlegm, and age at asthma onset. Analyses were stratified according to ICS use. Uncontrolled asthma was more frequent in ICS users (27.6%, 35.0%, and 37.4% with controlled, partly-controlled, and uncontrolled asthma respectively) compared with non-ICS users (60.0%, 23.9%, and 16.1%, respectively). In ICS users, chronic cough or phlegm and female sex were independently and significantly related to uncontrolled asthma. In non-ICS users, high total IgE and sensitization to molds were associated with uncontrolled asthma. Smoking and rhinitis were not associated with asthma control. Optimal asthma control remained unachieved in the majority of patients with asthma in this study. Factors associated with uncontrolled asthma were different in ICS users (chronic cough/phlegm, female sex) and non-ICS users (high total IgE and sensitization to molds).

RESULTS

No. of visits of GP/asthma nurses

Paired Samples Statistics

Mean

N

Std. Deviation

Std. Error Mean

Pair 1

baselinegpasthmanurse

8.4286

7

5.02849

1.90059

week16gpasthmanurse

.4286

7

.78680

.29738

Paired Samples Correlations

N

Correlation

Sig.

Pair 1

baselinegpasthmanurse & week16gpasthmanurse

7

-.265

.566

Paired Samples Test

Paired Differences

Mean

Std. Deviation

Std. Error Mean

95% Confidence Interval of the Difference

t

df

Sig. (2-tailed)

Lower

Upper

Pair 1

baselinegpasthmanurse - week16gpasthmanurse

8.00000

5.29150

2.00000

3.10618

12.89382

4.000

6

.007

Baseline data and week 16 adjusted data for mean number of hospital admissions

Paired Samples Statistics

Mean

N

Std. Deviation

Std. Error Mean

Pair 1

baselinehosp

3.8182

11

3.45885

1.04288

week16hospadjusted

2.1818

11

4.46807

1.34717

Paired Samples Correlations

N

Correlation

Sig.

Pair 1

baselinehosp & week16hospadjusted

11

.727

.011

Main personal, sociodemographic, and clinical characteristics of the population with asthma are presented in above table. The mean age of the population was 39 years, and half of the subjects were nonsmokers and not exposed to tobacco smoke at the time of the survey. Regarding allergic phenotypes, 60.2% reported allergic rhinitis, 61.3% had total IgE =100 IU/mL, and 80.8% were sensitized to any of the 11 allergens. Chronic cough or phlegm was reported by 16% of the subjects. Patients with asthma treated with ICS in the past 12 months were significantly older, were more often recruited as asthmatic cases at inclusion, were more often nonsmokers and not exposed to passive smoking, and more often reported chronic cough or phlegm than subjects who did not use ICS in the past 12 months.

Paired Samples Test

Paired Differences

Mean

Std. Deviation

Std. Error Mean

95% Confidence Interval of the Difference

t

df

Sig. (2-tailed)

Lower

Upper

Pair 1

baselinehosp - week16hospadjusted

1.63636

3.07482

.92709

-.42933

3.70206

1.765

10

.108

The distribution of the 3-level asthma control classification and each of the 1-dimensional criteria of asthma control are presented according to ICS. For each of the 1-dimensional aspects of asthma control, ICS users systematically presented uncontrolled asthma more often. Regarding the 3-level composite asthma control classification, only one fourth of the ICS users had controlled asthma, compared with 60% of ...