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

Abstract

Background

Risk factors for poor asthma outcomes may have considerable influence on the control level and medical care of asthmatic patients. Our objective was to conduct a study that provides data on the level of symptom control and the frequency of specific risk factors for poor asthma outcomes on a large patient cohort.

Methods

A cross-sectional, non-interventional real-life study was conducted among asthmatic patients treated by respiratory specialists in Hungary. Asthma control and risk factor assessment were done according to Global Initiative for Asthma guideline (Box 2–2). In the data analysis, phase descriptive statistics, graphical outputs, and Fisher’s exact tests were used.

Results

Of 12743 patients enrolled by 187 specialists, asthma was well controlled in 36.0%, partially controlled in 29.29%, and uncontrolled in 34.71% of the cases. The most common comorbidities were rhinitis/sinusitis (66.84%), cardiovascular diseases (43.81%), and gastroesophageal reflux disease (20.11%). The following risk factors had the strongest relationship with uncontrolled disease: incorrect inhaler technique causing side effects (odds ratio, OR 4.86, 3.51–6.8), previous severe exacerbation (OR 4.79, 4.02–5.72), high short-acting beta agonist (SABA) use (OR 4.46, 4.03–4.93), incorrect inhaler technique associated with an exacerbation (OR 3.91, 3.06–5.03), and persistently low forced expiratory volume in 1 s (FEV₁, OR 3.14, 2.8–3.52). The most frequent risk factors were smoking (OR 1.47, 1.36–1.59) and obesity (OR 1.34, 1.24–1.45). Furthermore, high loss of control was associated with an initial low FEV₁ (OR 2.21, 2.01–2.44), frequent oral corticosteroid (OCS) use (OR 1.83, 1.64–2.05), poor adherence to treatment (OR 2.51, 2.21–2.86), and allergen exposure (OR 1.63, 1.47–1.81).

Conclusions

This study indicated that the presence of risk factors for poor asthma outcomes listed by the Global Initiative for Asthma document significantly influenced actual control level in a real-world large patient cohort, with high SABA use, previous severe exacerbation, incorrect inhaler technique, persistently low FEV₁, and poor adherence to treatment having the highest impact.

Keywords:

• asthma
• risk factors
• poor outcomes
• exacerbation
• reliever use
• comorbidity

Acknowledgments

The authors thank to Abonyi-Tóth Zsolt (Data Processor Ltd.) for statistical analysis and to Proof-Reading-Service.com Ltd. for language check. The study was funded by Chiesi Hungary Ltd.

Abbreviation list

OR, odds ratio; CI, confidence intervals; COPD, chronic obstructive pulmonary disease; GINA, Global Initiative for Asthma; HR-QoL, health-related quality of life; eCRF, electronic case report form; GCP, good clinical practice; FEV₁, forced expiratory volume in 1 s; FVC, forced vital capacity; BMI, body mass index; GERD, gastroesophageal reflux disease; IGT, Impaired glucose tolerance; SABA, short-acting beta agonist; ICS, inhaled corticosteroid, ICU, intensive care unit.

Ethics approval and consent to participate

All procedures were performed in accordance with the ethical standards of the National Scientific and Research Ethics Committee of Hungary (ad.7864-2/2015/EKU [ad.48/2015]) and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Availability of data and materials

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

Author contributions

GT contributed to conception and design of the study, to literature search, and writing the manuscript. AH participated in literature search and made contributions to the acquisition and interpretation of data, and revised the manuscript. VM contributed to the literature search and revised the manuscript. LT and ZS contributed to conception and design of the study, to the acquisition and interpretation of data, and revised the manuscript. All authors contributed to data analysis, drafting and revising the article, gave final approval of the version to be published, and agree to be accountable for all aspects of the work.

Disclosure

VM, LT, and ZS had consultant arrangements with AstraZeneca, Berlin-Chemie, Boehringer Ingelheim, Chiesi, GSK, Novartis, Orion, TEVA, and Takeda. GT and AH are employees of Chiesi Hungary Ltd. VM reports personal fees from GSK, AstraZeneca, Berlin Chemie, Chiesi, Boehringer Ingelheim, Novartis, Orion, and TEVA, including non-financial support from Takeda, outside the submitted work. The authors report no other conflicts of interest in this work.

Supplementary materials

Figure S1 Risk factors for exacerbation.

Figure S2 Risk factors for developing fixed airflow limitation.

Figure S3 Risk factors for medication side effects.