Uncontrolled asthma occurs in all GINA treatment steps and is associated with worse physical health – a report from the OLIN adult asthma cohort

Figures & data

Table 1. Basic characteristics of an adult asthma cohort by sex, GINA treatment steps, and asthma control, respectively.

	Women	Men		No treatment	Treatment steps 1–3	Treatment steps 4–5		Controlled asthma	Uncontrolled asthma
	n = 405	n = 309	p-value	n = 171	n = 365	n = 178	p-value	n = 538	n = 176	p-value
Women, n (%)				83 (48.5)	213 (58.4)	109 (61.2)	0.038	298 (55.4)	107 (60.8)	0.209
Age, mean (sd)	58.6 (16.0)	59.4 (11.9)	0.405	57.1 (11.8)	58.2 (12.5)	62.0 (12.0)	<0.001	57.5 (12.0)	63.2 (12.3)	<0.001
Age in years range	33–92	32–92		37–87	32-92	37–92		32–92	37–92
BMI, mean (sd)	28.5 (5.5)	29.3 (4.8)	0.048	28.9 (5.1)	28.5 (5.0)	29.3 (5.7)	0.146	28.6 (5.2)	29.5 (5.3)	0.046
Non-smoker, n (%)	208 (51.4)	140 (45.3)		75 (49.9)	190 (52.1)	83 (46.6)		273 (50.7)	75 (42.6)
Ex-smoker, n (%)	149 (36.8)	141 (45.6)		66 (38.6)	139 (38.1)	85 (47.8)		209 (38.8)	81 (46.0)
Current smoker, n (%)	48 (11.9)	28 (9.1)	0.050	30 (17.5)	36 (9.9)	10 (5.6)	0.002	56 (10.4)	20 (11.4)	0.166
FEV1% predicted, mean (sd)	89.1 (16.0)	81.9 (16.0)	<0.001	88.1 (13.6)	87.0 (16.0)	82.0 (19.0)	0.001	87.3 (15.3)	82.1 (19.0)	0.001
Uncontrolled asthma (ACT ≤ 19), n (%)	107 (26.4)	69 (22.3)	0.209	17 (9.9)	88 (24.1)	71 (39.9)	<0.001

Notes. p-values = Chi-square test, ANOVA or student’s T-test, as appropriate.

sd = Standard deviation; ACT = Astma Control Test.

p-Values <0.05 are given in bold.

Table 2. Asthma exacerbations, healthcare utilization and health status by sex, GINA treatment steps, and asthma control, respectively.

	Women	Men		No treatment	Treatment steps 1–3	Treatment steps 4–5		Controlled asthma	Uncontrolled asthma
	n = 405	n = 309	p-value	n = 171	n = 365	n = 178	p-value	n = 538	n = 176	p-value
Asthma exacerbation, n (%)
Asthma exacerbation last 12 months	102 (25.2)	51 (16.5)	0.005	19 (11.1)	66 (18.1)	68 (38.2)	<0.001	84 (15.6)	69 (39.2)	<0.001
Healthcare utilization due to respiratory symptoms, n (%)
Any healthcare visits last 12 months	135 (33.3)	73 (23.6)	0.005	27 (15.8)	98 (26.8)	83 (46.6)	<0.001	121 (22.5)	87 (49.4)	<0.001
Emergency room visits last 12 months	46 (11.4)	25 (8.1)	0.148	9 (5.3)	33 (9.0)	29 (16.3)	0.002	36 (6.7)	35 (19.9)	<0.001
Hospitalizations last 12 months	7 (1.7)	10 (3.2)	0.190	4 (2.3)	5 (1.4)	8 (4.5)	0.081	8 (1.5)	9 (5.1)	0.006
Follow-up visits, n (%)
≥1 Physician follow-up visit per year	86 (21.2)	45 (14.6)	0.022	2 (1.2)	71 (19.5)	58 (32.6)	<0.001	81 (15.1)	50 (28.4)	<0.001
≥1 Nurse follow-up visit per year	41 (10.1)	35 (11.3)	0.605	2 (1.2)	41 (11.2)	33 (18.5)	<0.001	51 (9.5)	25 (14.2)	0.078
Health status assessed with SF-8, m (sd)^a
Physical component score	45.4 (9.6)	47.6 (9.0)	0.002	46.2 (9.5)	47.0 (9.3)	45.1 (9.4)	0.100	47.9 (9.0)	41.6 (8.9)	<0.001
Mental component score	49.2 (9.7)	51.8 (8.0)	<0.001	50.7 (8.4)	49.8 (9.4)	51.1 (9.0)	0.256	51.0 (8.5)	48.1 (10.3)	0.001

Notes. p-values = Chi-square test, ANOVA or student’s T-test, as appropriate.

sd = Standard deviation.

^a n = 7 internal missing values.

p-Values <0.05 are given in bold.

Table 3. Asthma exacerbation, healthcare utilization and health status by subjects without asthma treatment, GINA treatment steps 1–3, and GINA treatment steps 4–5, comparing by asthma control.

	No treatment			Treatment steps 1–3			Treatment steps 4–5
	Controlled n = 154	Uncontrolled n = 17	p-value*	Controlled n = 277	Uncontrolled n = 88	p-value*	Controlled n = 107	Uncontrolled n = 71	p-value*	p-value**	p-value***
Asthma exacerbation, n (%)
Asthma exacerbation last 12 months	15 (9.7)	4 (23.5)	0.086	38 (13.7)	28 (31.8)	<0.001	31 (29.0)	37 (52.1)	0.002	0.013	<0.001
Healthcare utilization due to respiratory symptoms, n (%)
Any healthcare visits last 12 months	23 (14.9)	4 (23.5)	0.356	61 (22.0)	37 (42.0)	<0.001	37 (34.6)	46 (64.8)	<0.001	0.001	0.001
Emergency room visits last 12 months	7 (4.5)	2 (11.8)	0.206	16 (5.8)	17 (19.3)	<0.001	13 (12.1)	16 (22.5)	0.066	0.596	0.037
Hospitalizations last 12 months	4 (2.6)	0 (0.0)	0.501	2 (0.7)	3 (3.4)	0.059	2 (1.9)	6 (8.5)	0.038	0.215	0.285
Follow-ups visits, n (%)
≥1 Physician follow-up visit per year	1 (0.6)	1 (5.9)	0.057	50 (18.1)	21 (23.9)	0.230	30 (28.0)	28 (39.4)	0.112	0.009	<0.001
≥1 Nurse follow-up visit per year	1 (0.6)	1 (5.9)	0.057	27 (9.7)	14 (15.9)	0.111	23 (21.5)	10 (14.1)	0.213	0.555	<0.001
Health status assessed with SF-8, m (sd)****
Physical component score	46.9 (9.3)	39.7 (8.6)	0.002	48.5 (8.9)	42.1 (8.7)	<0.001	47.4 (8.9)	41.6 (9.2)	<0.001	0.585	0.191
Mental component score	51.0 (8.4)	48.0 (7.8)	0.168	50.8 (8.7)	46.7 (10.8)	0.002	51.8 (8.4)	50.0 (10.0)	0.202	0.135	0.600

Notes. p values = Chi-square test, ANOVA or student’s T-test, as appropriate.

sd = Standard deviation.

* p values comparing controlled and uncontrolled asthma among those with no treatement, in treatment steps 1–3 and in treatment steps 4–5, respectively.

** p values comparing those with uncontrolled asthma (no treatment, treatment steps 1–3 and treatment steps 4–5).

*** p values comparing those with controlled asthma (no treatment, treatment steps 1–3 and treatment steps 4–5).

**** n = 7 internal missing values.

p-Values <0.05 are given in bold.

Figure 1. Physical and mental dimensions of health status assessed with SF-8 (0–100, lower scores highlighting worse health status) by GINA treatment steps, comparing uncontrolled and controlled asthma.

Table 4. Asthma exacerbations, health care utilization and health status by GINA treatment steps 1–3.

	Treatment steps 1 (n = 125)	Treatment steps 2 (n = 104)	Treatment steps 3 (n = 136)	p-value
Uncontrolled asthma (ACT <19), n (%)	30 (24.0)	21 (20.2)	37 (27.2)	0.453
Asthma exacerbation, n (%)	13 (10.4)	21 (20.2)	32 (23.5)	0.018
Any healthcare visits, n (%)	26 (20.8)	31 (29.8)	41 (30.1)	0.170
Emergency room visits, n (%)	7 (5.6)	10 (9.6)	16 (11.8)	0.216
≥1 Physician follow-up visit per year, n (%)	11 (8.8)	20 (19.2)	40 (29.4)	0.001
≥1 Nurse follow-up visit per year, n (%)	9 (7.2)	12 (11.5)	20 (14.7)	0.158
Physical component score, m (sd)^a	47.3 (9.3)	46.7 (9.6)	46.8 (9.1)	0.866
Mental component score, m (sd)^a	49.3 (9.8)	50.5 (9.5)	49.6 (8.9)	0.665

Notes. p-values = Chi-square test or ANOVA as appropriate.

sd = Standard deviation; ACT = Asthma Control Test.

Treatment step 1 = short-acting Beta2 agonist (SABA) or long-acting beta2 agonist (LABA) w/o inhaled corticosteroids (ICS).

Treatment step 2 = ICS as-needed.

Treatment step 3 = ICS low dose maintenance.

^a n = 4 internal missing values.

p-Values <0.05 are given in bold.

Figure 2. A visualized description of the association between health status, asthma control and pharmacological treatment respectively, among subjects with asthma. Asthma control and treatment levels are associated while health status is associated with asthma control but not with the level of treatment.