Controlled and uncontrolled allergic asthma in routine respiratory specialist care – a clinical–epidemiological study in Germany

Abstract

Background:

Studies in the last decade showed high rates of poorly treated and poorly controlled asthma in the community. Extending these findings we describe the more recent situation in specialist respiratory care as the most frequent source of treatment provision using comprehensive clinical and patient assessments and exploring predictors for poor control.

Methods:

This is a German cross-sectional, clinical epidemiological study in a nationally representative stratified treatment prevalence sample of N = 572 outpatients diagnosed with allergic asthma (AA; females 58.2%, aged 47.5 ± 16.3 (16–81 years). Treating physicians completed standardized clinical assessments (lung function, laboratory, clinical findings, severity, illness and treatment history, asthma control [GINA]), supplemented by patients’ self-report measures (EQ5-D, AQLQ, ACT) and mental health module (CIDI-SF).

Results:

A total of 65.4% of patients were rated (GINA) as controlled, 30.3% partially controlled, and 4.4% uncontrolled; the patient-rated ACT showed lower rates of control (19.9% controlled, 44.2% partial, 35.8% uncontrolled, kappa: 0.2). Consistent with findings of clinical measures, controlled asthma was highest among patients with pre-treatment stage I severity (83.6%) and decreased by pre-treatment severity (stage IV patients: 29.3%). Poorer control was associated with pre-treatment severity, nocturnal attacks, diminished adherence and comorbid anxiety/depression. Patients received complex multiple drug and non-drug interventions, largely consistent with guidelines. Degree of asthma control was associated with improved and even normalized quality of life findings.

Conclusion:

In this representative sample of longterm treated AA patients in specialist respiratory care we find better control rates and better adherence to guidelines as previous studies. Despite remarkable differences in clinician- vs patient-rated control ratings even the initially most severe stage IV patients (12.9% of patients) showed remarkable control rates and close to normal quality of life. Intensified treatment (e.g. omalizumab) was associated with improved control. Poorer control was associated with higher initial severity, diminished adherence, comorbid anxiety/depression and old age.

Limitation:

Findings apply to AA patients in respiratory specialist care sector which is likely to treat the more severely affected patients. Thus, findings cannot be generalized to the general population, other treatment settings or asthma types.

Key words::

• Asthma
• Asthma control
• Quality of life
• Severe allergic asthma

Transparency

Declaration of funding

The sap-NEEDs (Severe Allergic Asthma: Prevalence and Current Treatment Needs) study was supported by an unrestricted educational grant (Novartis Pharma GmbH, Nuremberg). The sponsor had no role in the preparation of this article.

Declaration of financial/other relationships

H.-U.W. has received an unrestricted educational grant from Novartis (Germany) for the sap-NEEDs study. R.B. has received reimbursement for attending scientific conferences and/or fees for speaking and/or consulting from AstraZeneca, Boehringer Ingelheim, Chiesi, GlaxoSmith Kline, Novartis, Nycomed and Pfizer. The Pulmonary Department at Mainz University Hospital received financial compensation for services performed during participation in clinical trials organized by various pharmaceutical companies. P.K. has received consultation fees and funding for travel to the ERS (2008) and ATS (2011) from Novartis. He is also a member of the speakers bureau of Novartis. His group practice is the recipient of funding from 2001–2003 from Novartis as research grants for participating in multi-center clinical trials. He received consulting and or speaking fees from following companies: AstraZeneca, Bionorica, Boehringer Ingelheim, Chiesi, GlaxoSmith Kline, MSD, Mundipharma and Nycomed. K.R. has received consulting fees from Novartis. S.M., J.K., T.R. and O.R. have disclosed that they have no significant relationships with or financial interests in any commercial companies related to this study or article.

Acknowledgments

We would like to thank all participating physicians for their help and support. Many thanks go also to our colleague Ms Marie Christine Dekoj for her assistance in coordinating the field work of the study.

Members of the sap-NEEDs study group are: R. Brehler (Münster), A. Hellmann (Augsburg), P. Kardos (Frankfurt), H. Magnussen (Großhansdorf), D. Nowak (München), K. Rabe (Großhansdorf), R. Rychlik (Burscheid), T. Ritz (USA-Dallas), U. Wahn (Berlin), H. Worth (Fürth), S. Zielen (Frankfurt).