Getting asthma under control is key to reducing hospitalizations and emergency department visits for the condition. But as respiratory therapists who work with asthma patients know all too well, gaining that control can be an uphill battle.
New research from Spanish investigators bears that out. In a study conducted among 1299 asthma patients with uncontrolled disease at baseline who were being treated in routine clinical practice, only 32.8% were able to meet the 2010 criteria for well-controlled asthma issued by the Global Initiative for Asthma (GINA).
Specific results showed –
- 6% of patients required at least one step up in treatment; 6% required more than two.
- For most patients, stepping up involved increased use of fixed combinations of ICS plus LABA.
- For patients who did not step up treatment, optimizing inhaler technique and treatment advice were sufficient.
- Short-acting β2-agonists were being used by only 66.7% of the patients.
- Older age, being overweight or obese, non-steroidal anti-inflammatory drug hypersensitivity, longer duration and worse severity of disease, poorer lung function, and greater bronchodilation were associated with poor asthma control.
The authors note adherence was not linked to poor asthma control and improved in all groups, but they believe this finding could be due to the fact that the participants were taking part in a study on asthma control. After treatment optimization, participants with poor adherence to inhaled treatment and a lack of knowledge about how to control their asthma were more likely to have worse asthma symptoms.
The researchers believe education plans that include therapeutic guidelines negotiated with the patient might help patients better adhere to their medications.
Lastly, the study compared the GINA 2010 and Asthma Control Test (ATC) criteria for well-controlled asthma, finding a serious disconnect between the two. While only 32.8% of patients met the GINA criteria, 57.2% met the criteria outlined by the ACT, suggesting choice of instrument to measure control could impact the patient’s plan of care.