Factors Associated with Asthma Control among Adults in Five New England States, 2006–2007

Abstract

Background. Despite the National Asthma Education and Prevention Program (NAEPP) guidelines that specify the goals of asthma control and management strategies, the number of patients with uncontrolled asthma remains high, and factors associated with uncontrolled asthma are unknown. Objective. The aim was to examine the relationship between asthma control and socio-demographic characteristics, health-care access and use, asthma education, and medication use among adults with active asthma residing in New England. Methods. Data from the 2006–2007 Behavior Risk Factor Surveillance System Adult Asthma Call-Back Survey were analyzed using multinomial logistic regression. Asthma control was categorized as “well controlled,” “not well controlled,” or “very poorly controlled” according to the NAEPP guidelines. Results. Of the respondents (n = 3079), 30% met the criteria for well-controlled asthma, 46% for not well-controlled asthma, and 24% for very poorly controlled asthma. Being of Hispanic ethnicity (odds ratio [OR] = 4.0; 95% confidence interval [CI] = 1.2–13.7), unemployed or unable to work (OR = 17.9; 95% CI = 6.0–53.4), high school educated or less (OR = 2.8; 95% CI = 1.6–4.7), current smokers (OR = 2.5; 95% CI = 1.3–5.1), or being unable to see a doctor or specialist for asthma care or unable to buy medication for asthma because of cost (OR = 7.6; 95% CI = 3.4–17.1) were associated with very poorly controlled asthma. In addition, having Coronary Obstructive Pulmonary Disease (COPD) (OR = 2.6; 95% CI = 1.5–4.5), two or more routine checkups for asthma (OR = 4.5; 95% CI = 2.3–8.9), or an emergency department visit, urgent care facility visit, and hospitalization in the past year (OR = 3.9; 95% CI = 2.1–7.3) were also associated with having very poorly controlled asthma. Using controller medication in the past year (OR = 2.6; 95% CI = 1.6–4.2) and taking a course on how to manage asthma (OR = 3.0; 95% CI = 1.2–7.8) were significantly associated with poor asthma control. Conclusion. The high prevalence (70%) of not well-controlled asthma and poorly controlled asthma in this study emphasizes the need to identify factors associated with poor asthma control for development of targeted intervention. A health policy of increasing asthma education, health-care access, and smoking cessation may be effective and result in better asthma control and management.

• access to health care
• asthma
• cross-sectional study
• education
• socio-demographic factors

Acknowledgments

The authors thank State Health Departments in Connecticut, Maine, Massachusetts, New Hampshire, and Vermont for lending their data set for our analyses. In addition, we are grateful to Paul Garbe, D.M.V., Cathy Bailey, M.S., and Fuyuen Yip, Ph.D., M.S., of the Air Pollution and Respiratory Health Branch at the Centers for Disease Control and Prevention. Funding for this study was provided by the Centers for Disease Control and Prevention, Grant Number 5U59EH124179-05. This article was presented at the Behavior Risk Factor Surveillance Survey Conference in San Diego, CA, March 23, 2010. The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

Declaration of Interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.