Determinants of Asthma Control in Tertiary Level in Turkey: A Cross-Sectional Multicenter Survey

Abstract

Objective. Recent data demonstrate that control of asthma is far from optimal worldwide. The aim of this study was to evaluate the level of asthma control in tertiary health services by the use of Asthma Control Test™ (ACT) and to assess the factors which might influence the control of the disease. Methods. A total of 2336 patients with asthma were recruited from 28 tertiary hospitals in the study. Asthma severity was classified by the frequency of asthma symptoms, pulmonary function tests, and medication requirements according to asthma guidelines. The level of asthma control was assessed by the Turkish version of ACT and determinants of asthma control were evaluated with medical history, physical examination, patients’ and disease characteristics. Results. Due to missing data, 1188 subjects’ records were evaluated. Nearly half of the patients (51.5%) were found to be “controlled” (ACT ≥20) and 48.5% was defined as “uncontrolled” (ACT < 20). The ratio of uncontrolled asthmatic patients was significantly higher in severe asthmatics than in mild and moderate asthmatics (p < .01). Female sex, education below secondary level, forced expiratory volume in one second (FEV₁) value <80%, peak expiratory flow (PEF) value <80%, hospitalization/emergency department visits in the last year, and systemic steroid use were found to be significantly associated with inadequate control (p < .01). Conclusions. This study demonstrated that asthma control was still inadequate in the tertiary level although overall control was better than previous reports in Turkey. Patients with severe asthma were more likely to have uncontrolled disease; worse asthma control was also associated with increased hospitalizations and emergency care admissions.

Keywords :

• asthma
• asthma control test
• control
• determinants

The Study Group

Peri Arbak (Abant İzzet Baysal University, Medical Faculty, Department of Pulmonary Diseases, Duzce), Candan Ogus (Akdeniz University, Medical Faculty, Department of Pulmonary Disease, Antalya), Dilsad Mungan (Ankara University, Medical Faculty, Department of Pulmonary Disease, Ankara), Nermin Capan (Atatürk Hospital for Chest Diseases and Thoracic Surgery, Ankara), Leyla Saglam (Atatürk University, Medical Faculty, Department of Pulmonary Disease, Erzurum), Arzu Yorgancioglu, Pınar Çelik (Celal Bayar University, Medical Faculty, Department of Pulmonary Disease, Manisa), Oznur Abadoglu (Cumhuriyet University, Medical Faculty, Department of Pulmonary Disease, Sivas), Tekin Yildiz (Dicle University, Medical Faculty, Department of Pulmonary Disease, Diyarbakir), Arif Çimrin (Dokuz Eylül University, Medical Faculty, Department of Pulmonary Disease, Izmir), Munevver Erdinc (Ege University, Medical Faculty, Department of Pulmonary Disease, Izmir), Inci Gulmez, Hakan Buyukoglan (Erciyes University, Medical Faculty, Department of Pulmonary Disease, Kayseri), Tulin Yilmaz Kuyucu (Fatih Sultan Mehmet Education and Training Hospital), Figen Deveci (Fırat University, Medical Faculty, Department of Pulmonary Disease, Elazig), Haluk Turktas, Kivilcim Oguzulgen (Gazi University, Medical Faculty, Department of Pulmonary Disease, Ankara), Bilun Gemicioglu (I.U Cerrahpasa Medical Faculty, Medical Faculty, Department of Pulmonary Disease, Istanbul), Caglar Cuhadaroglu (I.U. Istanbul Medical Faculty, Medical Faculty, Department of Pulmonary Disease, Istanbul), Serir Ozkan (Suat Seren Hospital For Chest Diseases and Thoracic Surgery, Izmir), Yilmaz Bulbul (Karadeniz Technical University, Medical Faculty, Department of Pulmonary Disease, Trabzon), Fusun Yildiz (Kocaeli University, Medical Faculty, Department of Pulmonary Disease, Kocaeli), Berrin Ceyhan (Marmara Üniversity, Medical Faculty, Department of Pulmonary Disease, Istanbul), Adil Zamani (Selcuk University, Medical Faculty, Department of Pulmonary Disease, Konya), Esen Akkaya (Süreyyapaşa Hospital for Chest Diseases and Thoracic Surgery, Istanbul), Gungor Camsari (Yedikule Hospital for Chest Diseases and Thoracic Surgery, Istanbul), Sadik Ardic, Arif Kelesoglu (Yildirim Beyazid Education and Training Hospital).