Health care education, delivery, and quality
Influence of patients' characteristics and disease management on asthma control

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Background

Although asthma control is a major outcome in disease management, little is known about its determinants.

Objectives

We sought to study the relationships between asthma control and patient characteristics or asthma management.

Methods

Asthmatic patients (age 18-50 years) who were regular customers of pharmacies and had a prescription for an antiasthma medication were recruited consecutively. Patients completed a questionnaire, which was complemented by computerized pharmacy records of previously dispensed medications. Asthma control (adequate/inadequate) was assessed with the Asthma Control Test. Determinants of asthma control were identified by means of multivariate logistic regression analysis.

Results

The mean age of the 1351 patients included was 36.8 years (SD, 9.8), and 55.8% were women. A minority of patients were considered to have had their symptoms adequately controlled. Smoking, female sex, and a body mass index of greater than 30 kg/m2 were all independent determinants of inadequate control. Compared with patients receiving inhaled corticosteroid monotherapy, those who were dispensed fixed combinations of inhaled corticosteroids and long-acting β-agonists presented with a significantly lower risk of inadequate asthma control (odds ratio, 0.58; 95% CI, 0.35-0.96).

Conclusion

Asthma control varied according to both the patients' characteristics and therapy.

Clinical implications

Our results strongly support the need to improve asthma control, especially in primary care and in women. A regular use of fixed controller combinations, helping patients to quit smoking, or addressing weight issues might contribute to improvement in asthma control.

Section snippets

Study design and study population

The methodology of the study has been described in detail.6 Briefly, a retrospective observational study was conducted in 348 community pharmacies between November 2003 and June 2004. Community pharmacists invited asthmatic patients aged 18 to 50 years who were regular users of the pharmacy to participate in the study. To be eligible, patients were required to have with them a prescription for an antiasthma medication (R03, Anatomical Therapeutical and Chemical Classification). The Anatomical

Results

Of the 1351 patients who met the inclusion criteria, data on asthma control were available for 1282 of them (Fig 1).

Discussion

This is one of the few observational studies conducted in asthmatic patients to identify determinants of inadequate control. Besides confirming the unsatisfactory status of asthma management (in our sample most patients were considered as not optimally controlled), we identified several independent patient-related determinants of inadequate control (ie, female sex, active smoking, and overweight status). Control also varied according to the type of asthma supervision (GPs and specialists).

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    Supported in part by a nonconditional grant from GSK France.

    Disclosure of potential conflict of interest: J. Bousquet has consultant arrangements with AstraZeneca, GlaxoSmithKline, Merck, Sharp, and Dhome and is on the speakers' bureau for AstraZeneca, GlaxoSmithKline, Merck, Sharp, and Dhome. The rest of the authors have declared that they have no conflict of interest.

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