Prevalence and impact of risk factors for poor asthma outcomes in a large, specialist-managed patient cohort: a real-life study

Figures & data

Table 1 Inclusion and exclusion criteria

Inclusion criteria	Exclusion criteria
- Adult asthmatic patients - Asthma diagnosis for >6 months - Maintenance therapy unchanged in the last month - Out-patient - No hospitalisation in the last month - No significant, untreated chronic disease	- Lack of consent by patient - Inability to complete patient related questionnaires - Permanent need for maintenance systemic corticosteroid treatment - Acute exacerbations at time of inclusion in study - Active tuberculosis - Malignant disease in a palliative treatment phase

Table 2 Main demographic data, clinical characteristics and lung function parameters of patients

		Study population
		N	%
Number of patients		12743	100
Number of cases in regions of Hungary	East	5149	40.4
	West	3984	31.3
	Central	3610	28.3
Examined patients according to seasonality	April–September	6923	54.3
	October–March	5820	45.7
Years since the diagnosis of asthma	0–1 years	310	2.4
	2–5 years	3280	25.7
	6–10 years	3295	25.9
	11–20 years	3930	30.8
	>20 years	1913	15.0
	No data	15	0.1
GINA based treatment categories	STEP 1	274	2.15
	STEP 2	990	7.77
	STEP 3	4759	37.35
	STEP 4	6390	50.14
	STEP 5	330	2.59
Gender	Male	4059	31.9
	Female	8684	68.1
Smoking habit	Smoker	1669	13.1
	Former smoker	2584	20.3
	Never smoked	8476	66.5
	No data	14	0.1
Age distribution	18–30	1261	9.9
	31–45	2466	19.4
	46–65	5687	44.6
	>65	3329	26.1
Body mass index distribution	<18.5	228	1.8
	18.5–24.9	3453	27.1
	25–29.9	4487	35.2
	30–34.9	3009	23.6
	≥35	1566	12.3
FEV1 (forced expiratory volume in 1 s, % predicted) distribution	>80%	7527	59.1
	60–80%	3399	26.7
	<60%	1461	11.5
	No data	356	2.8

Abbreviation: GINA, global initiative for asthma.

Table 3 Comorbidities of study participants (data are presented as numbers and percentages)

Comorbidities	N	%
Cardiovascular disease	5583	43.81
Hypertension	5226	41.01
Cardiac insufficiency	1250	9.81
Acute myocardial infarction	210	1.65
Atrial fibrillation (chronic)	160	1.26
Other cardiac arrhythmia	731	5.70
Other cardiac history	215	1.69
Rhinitis and/or Sinusitis	8517	66.84
Gastroesophageal reflux disease (GERD)	2563	20.11
Diabetes	1129	8.86
Impaired glucose tolerance (IGT)	1058	8.30
Concomitant COPD	1002	7.86
Osteoporosis	1081	8.48
Prostate hyperplasia	317	2.49
Glaucoma	227	1.78
Cerebrovascular events	311	2.44
Other comorbidities	1320	10.36

Figure 1 Proportion of patients with different levels of asthma control according to GINA guideline.

Table 4 Frequency of risk factors, control levels of affected patients, and relationship between the risk factor and uncontrolled status (Fisher’s exact test odds ratio)

	Risk factors	Number of patients affected by the risk factor	Frequency of risk factor	Ratio of uncontrolled patients	Number of uncontrolled patients	Number of partly controlled patients	Number of well- controlled patients	Odds ratios (95% CI)	p-value
Risk factors for exacerbation
1	Excessive SABA use (>1 pack/month)	2045	16.05%	64.55%	1,320	460	265	4.46 (4.03-4.93)	p<0.001
2	Inadequate ICS (not prescribed ICS, poor adherence, no proper inhaler technique)	2250	17.66%	44.36%	998	679	573	1.64 (1.50-1.81)	p<0.001
2a	Poor adherence	1076	8.44%	55.11%	593	332	151	2.51 (2.21-2.86)	p<0.001
2b	Incorrect inhaler technique in connection with exacerbation	304	2.39%	66.78%	203	69	32	3.91 (3.06-5.03)	p<0.001
3	Low FEV1<60% predicted (actual)	1461	11.47%	59.14%	864	327	270	3.14 (2.80-3.52)	p<0.001
4	Exposures (smoking, allergen exposure if sensitized)	10,210	80.12%	35.57%	3632	2991	3587	1.22 (1.11-1.35)	p<0.001
5	Comorbidities (Overweight, rhinosinusitis, confirmed food allergy)	10,193	79.99%	35.34%	3602	3007	3584	1.15 (1.05-1.27)	p=0.002
5a	Obesity (above BMI 30)	4575	35.90%	39.04%	1786	1353	1436	1.34 (1.24-1.45)	p<0.001
5b	Allergen exposure if sensitized (allergen history administered)	8517	66.84%	34.79%	2963	2462	3092	1.01 (0.94-1.09)	p=0.767
5b1	Allergen exposure if sensitized (in the patient’s allergic season)	1786	14.02%	44.62%	797	561	428	1.63 (1.47-1.81)	p<0.001
6	Pregnancy	43	0.34%	25.58%	11	13	19	0.65 (0.29-1.32)	p=0.261
7	Ever intubated or in intensive care unit for asthma	83	0.65%	56.63%	47	15	21	2.47 (1.56-3.93)	p<0.001
8	≥1 severe exacerbation in last 12 months	651	5.11%	70.05%	456	115	80	4.79 (4.02-5.72)	p<0.001
Risk factors for developing fixed airflow limitation
9	Lack of ICS treatment	1331	10.44%	35.24%	469	418	444	1.03 (0.91-1.16)	p=0.67
10	Exposures (Tobacco smoke, noxious chemicals, occupational exposures)	4736	37.17%	41.22%	1952	1423	1361	1.58 (1.46-1.70)	p<0.001
10a	Tobacco smoke (history of active smoking)	4253	33.38%	40.58%	1726	1292	1235	1.47 (1.36-1.59)	p<0.001
10a1	Smoking (currently active smokers)	1669	13.10%	42.30%	706	512	451	1.58 (1.42-1.76)	p<0.001
10b	Noxious chemicals or occupational exposures	793	6.22%	48.68%	386	227	180	1.86 (1.60-2.15)	p<0.001
11	Low initial FEV1 (<60% predicted)	1999	15.69%	50.73%	1,014	508	477	2.21 (2.01-2.44)	p<0.001
Risk factors for medication side effects
12	Systemic side effect	1550	12.16%	47.23%	732	369	449	1.82 (1.63-2.03)	p<0.001
12a	Frequent OCS	1513	11.87%	47.46%	718	353	442	1.83 (1.64-2.05)	p<0.001
12b	P450 inhibitor	52	0.41%	42.31%	22	17	13	1.38 (0.76-2.48)	p=0.247
13	No proper inhaler technique which caused side effect	190	1.49%	71.58%	136	33	21	4.86 (3.51-6.80)	p<0.001

Abbreviations: ICS, inhaled corticosteroid; BMI, body mass index; OCS, oral corticosteroid; SABA, short-acting beta agonist; FEV₁, forced expiratory volume in 1 s.

Figure 2 The frequency of specific risk factors and the odds ratio of its relationship with uncontrolled status.

Note: Size of bubbles represent the ratio of uncontrolled patients.
Abbreviations: BMI, body mass index; ICS, ICS, inhaled corticosteroid; OCS, oral corticosteroid; FEV₁, forced expiratory volume in 1s; SABA, short-acting beta agonist.

Figure S1 Risk factors for exacerbation.

Figure S2 Risk factors for developing fixed airflow limitation.

Figure S3 Risk factors for medication side effects.

Availability of data and materials

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.