Key factors associated with uncontrolled asthma – the Asthma Control in Latin America Study

Figures & data

Table 1. Pulmonologists-adjudicated decisions about patients’ asthma classifications and treatments, for cases where ERS/ATS 2014 guidelines were unclear.

Treatment Scheme Not Clearly Defined by ERS/ATS 2014	Classification Decision – Defined by 3 Pulmonologists
1: Patients using non-high dose of ICS + LAMA	Severe asthma
2: Patients using non-high dose of ICS + LABA + Anti-IgE	Severe asthma
3: Patients using OCS with other controllers that are not ICS	Severe asthma
4: Patients using non-high dose of ICS +2 or more controllers (leukotrienes receptor antagonist OR LABA OR xanthines (theophylline OR aminophylline)	Non-severe asthma

ICS: inhaled corticosteroids; LAMA: long-acting muscarinic receptor antagonist; LABA: long-acting β₂-agonist; Anti-IgE: anti-immunoglobulin E; OCS: oral corticosteroids.

Table 2. Characteristics of asthma patients by asthma control status in Argentina, Chile, Colombia and Mexico.

Independent Variables	Controlled		Uncontrolled		Total		Crude OR	95% CI	p value	Adjusted OR	95% CI	p value
	n = 258	(%)	n = 336	(%)	n = 594	(%)
Gender
Male	95	58.6	67	41.4	162	27.3	Reference			Reference
Female	163	37.7	269	62.3	432	72.7	2.36	(1.63–3.42)	<0.001	1.85	(1.23-2.77)	0.003
Age at study entry, years
12–19	31	50.8	30	49.2	61	10.3	Reference			Reference
20–29	48	61.5	30	38.5	78	13.1	0.60	(0.30–1.20)	0.149	0.47	(0.22–0.98)	0.044
30–39	31	37.3	52	62.7	83	14.0	1.59	(0.81–3.13)	0.180	1.25	(0.60–2.59)	0.555
40–49	40	35.7	72	64.3	112	18.9	1.76	(0.92–3.35)	0.085	1.13	(0.56–2.28)	0.734
50–59	43	35.8	77	64.2	120	20.2	1.73	(0.92–3.26)	0.089	1.07	(0.53–2.16)	0.843
≥60	65	46.4	75	53.6	140	23.6	1.10	(0.60–2.02)	0.758	0.72	(0.37–1.39)	0.320
Age at asthma diagnosis, years
≤9	71	47.0	80	53.0	151	25.4	Reference
10–25	73	47.7	80	52.3	153	25.8	0.97	(0.62–1.53)	0.903
26–41	55	37.7	91	62.3	146	24.6	1.44	(0.90–2.30)	0.124
≥42	59	41.0	85	59.0	144	24.2	1.25	(0.78–1.98)	0.352
Race/ethnicity*
White	165	54.8	136	45.2	301	50.8	Reference			Reference
Non-white	93	31.8	199	68.1	292	49.2	2.60	(1.86–3.64)	<0.001	2.14	(1.47–3.11)	<0.001
Nutritional status*
Underweight	6	42.9	8	57.1	14	2.4	1.24	(0.42–3.71)	0.696	2.07	(0.61–6.94)	0.240
Normal	98	48.5	104	51.5	202	34.1	Reference			Reference
Overweight	108	47.6	119	52.4	227	38.3	1.02	(0.70–1.49)	0.919	0.98	(0.64–1.51)	0.945
Obese	45	30.2	104	69.8	149	25.2	2.16	(1.38–3.37)	0.001	1.71	(1.04–2.84)	0.036
Family monthly income, USD*
≥668.5	162	54.4	136	45.6	298	50.2	Reference			Reference
<668.5	95	32.2	200	67.8	295	49.7	2.58	(1.84–3.60)	<0.001	1.75	(1.20–2.56)	0.004
Household members, n*
<3	78	45.3	94	54.7	172	29.0	Reference
≥3	180	42.8	241	57.2	421	70.9	1.14	(0.79–1.63)	0.482
Had at least one PEF test
Yes	66	49.3	68	50.7	134	22.6	Reference
No	192	41.7	268	58.3	460	77.4	1.36	(0.92–2.00)	0.123
Had at least one spirometry
Yes	174	43.8	223	56.2	397	66.8	Reference
No	84	42.6	113	57.4	197	33.2	1.05	(0.74–1.48)	0.800
Medication access level*
Complete access	186	40.3	275	59.7	461	77.6	Reference			Reference
No/Partial access	71	53.8	61	46.2	132	22.2	0.59	(0.40–0.88)	0.009	0.88	(0.57–1.37)	0.582
Treatment with ICS + LABA
Yes	181	43.2	238	56.8	419	70.5	Reference
No	77	44.0	98	56.0	175	29.5	0.98	(0.69–1.40)	0.921
Asthma severity
Non-severe	192	46.8	218	53.2	410	69.0
Severe Asthma	66	35.9	118	64.1	184	31.0	1.51	(1.05–2.17)	0.025	1.59	(1.06–2.38)	0.026
Treatment adherence*
High	58	45.3	70	54.7	128	21.6	Reference
Medium	98	48.3	105	51.7	203	34.2	0.89	(0.57–1.40)	0.623
Low	102	38.9	160	61.1	262	44.2	1.30	(0.85–2.00)	0.232

Note. Six patients were not included in the logistic model because they had missing information in at least 1 variable included in the model.

^* One missing.

CI: confidence interval; ICS: inhaled corticosteroids; LABA: long-acting β₂-agonist; OR: odds ratio; PEF: peak expiratory flow; USD: United States dollars.

Table 3. Healthcare resources used in previous 12 months and exacerbation frequency by asthma control status.

Clinical Characteristics	Controlled Asthma (n = 258)		Uncontrolled Asthma (n = 336)		Overall
	n	(%)	n	(%)	n	(%)	p-value
Hospital admissions due to asthma
Yes	8	3.1	23	6.9	31	5.2	0.042
No	250	96.9	313	93.1	563	94.8
Hospital admissions due to other causes
Yes	6	2.3	16	4.8	22	3.7	0.119
No	252	9.7	320	95.2	572	96.3
Hospital admissions
Due to asthma: mean (SD); median (IQR)	0.1 (0.3); 0.0 (0.0)		0.2 (1.4); 0.0 (0.0)		0.1 (1.1); 0.0 (0.0)		0.041
Due to other causes: mean (SD); median (IQR)	0.0 (0.4); 0.0 (0.0)		0.1 (0.5); 0.0 (0.0)		0.1 (0.4); 0.0 (0.0)		0.117
Asthma exacerbation
Yes	41	15.9	116	34.5	157	26.4	<0.001
No	217	84.1	220	65.5	437	73.6
Hospital admissions including ICU due to asthma
Yes	2	0.8	12	3.6	14	2.4	0.026
No	256	99.2	324	96.4	580	97.6
Hospital admissions including ICU due to other causes
Yes	3	1.2	9	2.7	12	2.0	0.193
No	255	98.8	327	97.3	582	97.9
Hospital admissions including ICU
Due to asthma: mean (SD); median (IQR)	0.0 (0.1); 0.0 (0.0)		0.1 (0.8); 0.0 (0.0)		0.1 (0.6); 0.0 (0.0)		0.025
Due to other causes: mean (SD); median (IQR)	0.0 (0.2); 0.0 (0.0)		0.0 (0.2); 0.0 (0.0)		0.0 (0.2); 0.0 (0.0)		0.196
ED visits due to asthma
Yes	41	15.9	116	34.5	157	26.4	<0.001
No	217	84.1	220	65.5	437	73.6
ED visits due to other causes
Yes	15	5.8	41	12.2	56	9.4	0.008
No	243	94.2	295	87.8	538	90.6
ED visits due to asthma requiring systemic (injectable) corticosteroid
Yes	28	10.9	93	27.7	121	20.4	<0.001
No	230	89.1	243	72.3	473	79.6
ED visits due to other causes requiring systemic (injectable) corticosteroid
Yes	7	2.7	16	4.8	23	3.9	0.200
No	251	97.3	320	95.2	571	96.1
ED visits
Due to asthma: mean (SD); median (IQR)	0.3 (1.1); 0.0 (0.0)		1.2 (5.8); 0.0 (1.0)		0.8 (4.4); 0.0 (1.0)		<0.001
Due to other causes: mean (SD); median (IQR)	0.1 (0.3); 0.0 (0.0)		0.2 (0.7); 0.0 (0.0)		0.1 (0.6); 0.0 (0.0)		0.007

ED: Emergency department; ICU: intensive care unit; SD: Standard deviation; IQR: Interquartile range.

Table 4. Use of asthma medications at the time of the interview according to asthma control status.

Medication Class	Controlled Asthma n (%)	Uncontrolled Asthma n (%)	Total n (%)	p value
Anti-immunoglobulin E agents	7 (2.7)	8 (2.4)	15 (2.5)	0.798
Anticholinergics	20 (7.8)	84 (25.0)	104 (17.5)	<0.001
Antihistamines	19 (7.3)	24 (7.1)	43 (7.2)	0.918
Inhaled corticosteroids only or in combination with any other asthma medication	237 (91.9)	307 (91.4)	544 (91.6)	0.831
Inhaled corticosteroids + LABA	181 (70.2)	238 (70.8)	419 (70.5)	0.857
Leukotriene antagonists	27 (10.5)	65 (19.4)	92 (15.5)	0.003
Short-acting beta-agonists	154 (59.7)	207 (61.6)	361 (60.8)	0.635
Systemic corticosteroids	3 (1.2)	17 (5.1)	20 (3.4)	0.009
Xanthine and adrenergics	7 (2.7)	9 (2.7)	16 (2.7)	0.979
Other	3 (1.2)	1 (0.3)	4 (0.7)	0.201

ICS: inhaled corticosteroids; LABA: long-acting β₂-agonists.