Factors Associated With the Control of Severe Asthma

Abstract

Introduction. Control is a priority treatment objective in asthma, and classification based on control is recommended in the follow-up of asthmatic patients. Different factors affect this control, and there are several regional differences, both in terms of prevalence and in terms of management and degree of control. Objective. To evaluate the factors associated with control of severe asthma in routine clinical practice. Material and Methods. This was a prospective, cross-sectional, observational study of patients with severe asthma who were receiving treatment with a fixed combination of a corticosteroid (at least 800 μg/day of budesonide or equivalent) and an inhaled β₂-adrenergic agonist in respiratory medicine and allergology clinics throughout Spain. The authors collected demographic and socioeconomic data, as well as clinical data on asthma. The patients also completed a self-administered validated questionnaire—the Asthma Control Questionnaire (ACQ)—about the control of their asthma. Results. The authors included 1471 patients, of whom 1224 (83%) were valid for the final analysis. Women accounted for 61%. Mean age was 51 ± 16 years. The mean number of exacerbations during the previous year was 2.0 ± 2.0. The global score on the ACQ was 1.8 ± 1.1 (0 = no symptoms; 6 = maximum number of symptoms). Only 20.4% of patients were well controlled (ACQ < 0.75), and 55.7% of patients were poorly controlled (ACQ > 1.5). The multivariate analysis revealed that the variable with the greatest effect on control of asthma was the number of exacerbations during the previous year: when the number of exacerbations increased from 0 to 1 or more, the ACQ score increased by 0.56 points. Employed patients had a mean of 0.23 points less (better control) than unemployed and retired patients. Control of asthma was also significantly affected by adherence to treatment, patient knowledge of the disease, body mass index, gender, and number of visits to a physician in the previous 3 months. Conclusions. Many patients with severe asthma have poor control of their disease. The number of exacerbations is the variable with the greatest effect on control of asthma. Knowledge of the disease and adherence to treatment are associated with better control.

Keywords :

• ACQ
• asthma control
• quality of life questionnaires
• severity-associated factors

Acknowledgments

We thank all the physicians who participated in patient recruitment:

Abel Rodriguez (Orense), Adalberto Pacheco (Madrid), Agustín Fernandez (Valencia), Aitor Ballaz (Bilbao), Albert Gunter (Palma de Mallorca), Alberto Caso (Sevilla), Alberto Herrejón (Valencia), Alejandro Salanova (Valencia), Alejandro Sánchez (Las Palmas), Alfonso Carreño (Murcia), Alfredo González (Gijón), Alfredo Iglesias (Madrid), Alicia Padilla (Málaga), Amparo Conde (Sevilla), Amparo Lanuza (Valencia), Amparo Romero (Palma de Mallorca), Amparo Zaragoza (Valencia), Ana del Rosario (Albacete), Ana M^a Castañar (Badajoz), Ana Maria Domínguez (Valencia), Ana M^a Losa (Madrid), Ana Mora González (Murcia), Ana Santiago (Madrid), Ana Souto (La Coruña), Andrés Cáceres (Madrid), Angel Francisco (Granada), Angel Moral (Toledo), Angel Sastre (Valencia), Antonio Álvarez (Barcelona), Antonio Arana (Málaga), Antonio Carbajal, Antonio Carbonell (Murcia), Antonio Cascales (Ibiza), Antonio García (Las Palmas), Antonio Hidalgo (Córdoba), Antonio Manuel Pérez (Badajoz), Antonio Plata (Málaga), Antonio Ruiz (Madrid), Antonio Varo (Córdoba), Apolinar Lezaun (Zaragoza), Aquilino Espejo (Granada), Asunción Nieto (Madrid), Aurelio González (Lugo), Aurioldo Contreras (Madrid), Aythamy Henríquez (Madrid), Bartolomé García (Murcia), Bartolomé Mascaro (Mallorca), Begoña Fernandez (Navarra), Berta Avilés (Barcelona), Carlos Colas (Zaragoza), Carlos Senent (Toledo), Carmen Aguirre (Zaragoza), Carmen Diego (La Coruña), Carmen Morales (Sevilla), Carmen Quintana (Huesca), Carmen Romero (Sevilla), Carmen Rubiano (Sevilla), Carmen Vidal (Coruña), Martin Carracedo (La Coruña), Clara Carballas (Lugo), Concepción Cordobés (Badajoz), Cristina Aguado (Córdoba), Cristina Alcaraz (Sevilla), Cristina López (Sevilla), Cristina Martínez (Valencia), Damián López (Murcia), David Jiménez (Madrid), David Orts (Alicante), Dolores Rueda (Cádiz), Eduardo Fernandez (Castellón), Elena Miguel (Barcelona), Elena Mora (Málaga), Eleuterio Llorca (Alicante), Emilia Hernanz (Valencia), Encarnación Antón (Santander), Encarnación Checa (Tarragona), Enrique Burches (Valencia), Enrique García (Murcia), Ernesto Centeno (Vizcaya), Esperanza Sanz (Cádiz), Esther Pinto (Barcelona), Eugenio Rodriguez, Francisco. Javier García (Murcia), Felipe Nicolau (Palma de Mallorca), Félix Martin (Burgos), Fernando Bernal (Madrid), Fernando Martin (Granada), Francisco David El-Qutob (Valencia), Francisco Espada (Málaga), Francisco Javier Álvarez (Sevilla), Francisco Ortega (Sevilla), Francisco Pando (Bilbao), Francisco Pascual (Alicante), Francisco Planas (Barcelona), Francisco Sierra (Córdoba), Gaspar Dalmau (Tarragona), Gema Díaz (Madrid), Gloria Garvayo (Granada), Guillermo González (Badajoz), Gustavo De Luis (Málaga), Héctor González (Tenerife), Hortensia Calderón (Granada), Ignacio Inchaurraga (Valencia), Ildefonso Del Pozo (Alicante), Inmaculada González (Málaga), Inmaculada Gorordo (Bilbao), Inmaculada Sánchez (Tenerife), Isabel Parra (Murcia), Isabel Suarez (Tenerife), Isabel Urrutia (Bilbao), Itziar Fernandez (León), Jaime Gómez (Murcia), Javier Aldea (Valencia), Javier Cuesta (Madrid), Javier De Miguel (Madrid), Javier Fullana (Valencia), Javier Guerra (Las Palmas), Javier Montoro (Castellón), Javier Moraza (Bilbao), Javier Reyes (Valencia), Javier Sanchez (Sevilla), Jesús Fernandez (Guadalajara), Jesús Maria Borja (Ciudad Real), Jesús Miguel García (Badajoz), Joan Manuel Gómez (Barcelona), Joaquín Angel Quiralte (Jaén), Joaquín Gómez (Murcia), Jordi Abad (Barcelona), Jordi Sans (Barcelona), Jorge Castelao (Guadalajara), Jorge Méndez (Palencia), José Alberto Martos (Barcelona), José Amat (Almería), José Angel Cumplido (Las Palmas), José Antonio Álvarez (Oviedo), José Arias (Huelva), José Cuellar (Cádiz), José Fernando Florido (Granada), José Ignacio Sánchez (Valencia), José Luis Álvarez-Sala (Madrid), José Luis Barrón (Salamanca), José Luis Calpe (Alicante), José Luis Delgado Redondela (Pontevedra), José Luis Ibor (Valencia), José Luis Martínez (Madrid), Jose Luis Ramia (Palma de Mallorca), José M^a Dura (Valencia), José M^a Negro (Murcia), José Maldonado Díaz (Barcelona), José Manuel Barceló (Málaga), José Manuel Valles (Valencia), José Maria Bofill (Barcelona), José Maria Hernández (Tenerife), José Meseguer (Murcia), José Miguel Fuster (Valencia), José Orlando Gras (Alicante), José Ramón Lavín (Valencia), José Rupérez (Murcia), José Vigaray (Madrid), Josefa García (Valencia), Juan Antonio Pagan (Murcia), Juan Antonio Romero (Málaga), Juan Fernandez Lahera (Madrid), Juan Fraj (Zaragoza), Juan Francisco Medina (Sevilla), Juan José Liñana (Valencia), Juan José Zapata (Almería), Juan Latour (Murcia), Juan Luis Anguita (Jaén), Juan Luis García (La Rioja), Juan Manuel Bravo (Jaén), Juan Ramis (Palma de Mallorca), Juan Vilaseca (Barcelona), Julia García (Madrid), Julio Álvarez (Granada), Julio Delgado (Sevilla), Julio Flores (Madrid), Julio Hernández (Madrid), Julio Manuel Palop (Valencia), Julio Rubio (Barcelona), Karina Portillo (Barcelona), Khaled Bdeir (Castellón de la Plana), Laia Ferrer (Valencia), Laura Pérez (Zaragoza), Lorenzo Pérez (Tenerife), Lourdes Fernandez (Badajoz), Luis Angel Navarro (Valencia), Luis Antonio Jaímez (Granada), Luis Fernandez De Rota (Málaga), Luis Mateos (Badajoz), Luis Miguel Domínguez (La Coruña), Luis Palacios (Jaén), M^a Ángeles Lara (Granada), M^a Ángeles Núñez (Melilla), M^a Belén De Mateo (Melilla), M^a Carmen Aguar (Castellón), M^a Carmen Castro (Madrid), M^a Carmen Maza (Jaén), M^a Cesárea Sánchez (Huelva), M^a Del Mar Garcés (Zaragoza), M^a Del Mar Jiménez (Toledo), M^a Dolores Rivera (Murcia), M^a Esperanza López (Granada), M^a Jesús Cremades (Valencia), M^a José Espinosa (Toledo), M^a José Pascual (Palma de Mallorca), M^a Josefa Peirón (Madrid), M^a Josefa Puerto (Badajoz), M^a Loreto Alemany (Murcia), M^a Lourdes Ramos (Palencia), M^a Teresa Martin (La Coruña), M^a Teresa Rio (Madrid), M^a Carmen Soto (Murcia), Macarena Rizo (Málaga), Magdalena Lluch (Toledo), Manuel Alcántara (Jaén), Manuel De Las Heras (Madrid), Manuel Martínez (Madrid), Manuela Alvarado (Cáceres), Mar Guilarte (Barcelona), Margarita Armisen (La Coruña), Maria Carmen Bermejo (Navarra), Maria Dolores Gil (Valencia), Maria Eugenia Casado (Cuenca), Maria José Benlloch (Valencia), Maria Soledad Hernández (Almería), Maria Teresa Luengo (Barcelona), Marina Blanco (La Coruña), Martin Correa (Alicante), Matias Vaquer (Palma de Mallorca), Matilde Gonzalo (Madrid), Matilde Martinez (Lleida), Merce Palau (Barcelona), Mercedes Corominas (Barcelona), Mercedes Martínez (Madrid), Miguel Angel García (Valencia), Miren Iosune Ormaza (Barcelona), Mohhammad Ali Al-Baech (Huelva), Myriam Aburto (Bilbao), Nicolás Jiménez (Albacete), Nieves Segura (Zaragoza), Oscar Bernadich (Barcelona), Oscar Veiras (Oviedo), Pablo Rubinstein (Barcelona), Patricia Lloberes (Barcelona), Pedro Álvarez (Santiago De Compostela), Pedro Angel Galindo (Ciudad Real), Pedro Jaime Carretero (Burgos), Pedro Jorge Marcos (La Coruña), Pedro Penela (La Coruña), Pilar Alba García-Baquero (Madrid), Pilar Cordero (Badajoz), Pilar De La Cuadra (Valencia), Pilar Roche (Zaragoza), Pilar Sánchez (Valladolid), Purificación González (Alicante), Rafael Castrodeza (León), Rafael De Los Reyes (La Coruña), Rafael Sáez (Madrid), Rafael Vidal (Madrid), Ramón Alkiza (Vizcaya), Raquel Pérez (Murcia), Raul Godoy (Albacete), Raul Moreno (Madrid), Remedios Guspi (Tarragona), Ricardo García (Madrid), Roberto Bernabéu (Alicante), Rosa De Celis (Barcelona), Rosa Romero (Sevilla), Ruth Barranco (Ávila), Said Nicolás Najm (Granada), Santiago Olalde (Madrid), Santiago Ramos (Oviedo), Segismundo Solano (Madrid), Serapio Sanchez (Valencia), Silvia Martínez (Valencia), Sisi Cojocairus (Pamplona), Susana Varela (Barcelona), Teresa Lamban (Zaragoza), Teresa Sánchez (Murcia), Valentina Gutiérrez (Valencia), Valentina Moggi (Palma de Mallorca), Vicente Bargues (Valencia), Victoria Cardona (Palma de Mallorca), Virginia Peris (Alicante), Virginia Rodriguez (La Coruña), Xavier Muñoz (Barcelona).