Assessment of asthma control in primary care

Abstract

Objective:

To determine the prevalence of uncontrolled asthma in patients who are visiting their primary care provider for any reason.

Research design and methods:

This multisite, cross-sectional survey was conducted between January 25 and May 2, 2008. Participants aged ≥18 years were recruited from 35 primary care provider sites. Eligible participants presented to the office for any acute medical, routine, follow-up, or nonmedical reason; had a self-reported physician diagnosis of asthma; used medication to treat asthma in the past year; and had no history of COPD. They completed the Asthma Control Test (ACT) and provided information including demographics, health behaviors, medical history, and asthma medication use. Uncontrolled asthma was defined as ACT score ≤19.

† Asthma Control Test is a trademark of QualityMetric, Inc., Lincoln, RI, USA.

Results:

The overall weighted prevalence of uncontrolled asthma in 2238 patients in primary care was 58% (95% confidence interval [CI], 0.56–0.60). Among asthma patients seeking care for a respiratory complaint, 72% (95% CI, 0.68–0.75) had uncontrolled asthma compared to 48% (95% CI, 0.45–0.51) of asthma patients presenting for a non-respiratory reason.

Conclusions:

At the population level, over half of patients with asthma under primary care management had uncontrolled asthma at the time of an office visit. Surprisingly, nearly 50% of patients with asthma who presented for office visits not associated with respiratory-related complaints had uncontrolled asthma. The study results may be influenced by a seasonal effect of upper respiratory infections and by the insurance status of the study respondents. However identifying patients with uncontrolled asthma is important and remains a challenge. Therefore, health care providers should consider evaluating asthma control on a regular basis, regardless of reason for visit.

Key words: :

• Asthma
• Asthma control
• Asthma Control Test
• Disease management
• Prevalence
• Primary care physicians

Transparency

Declaration of funding

This study was sponsored by GlaxoSmithKline.

Declaration of financial/other relationships

M.M. has disclosed that he contributed to the overall study concept and design; interpretation of the study data; and drafting of the manuscript. He also supplied important intellectual content for the paper. He has disclosed that he has served as a speaker and consultant for GlaxoSmithKline and AstraZeneca, and has also served as a speaker for Pfizer and Takeda.

A.G. has disclosed that she contributed to the overall study concept and design; acquisition of study data; study analysis and interpretation; drafting of the manuscript; obtaining funding and overall supervision for the study.

C.B. has disclosed that she contributed to the acquisition of study data; study analysis and interpretation; technical support and critical review of the manuscript.

R.Z. has disclosed that he contributed to the analysis and interpretation of the study data; led the statistical analysis and provided critical review and input to the manuscript.

A.G. has disclosed that she and R.Z. had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

A.G., C.L.B. and R.Z. have disclosed that they are employed by RTI Health Solutions, a business unit of RTI International, a nonprofit research organization. RTI Health Solutions receives funding from multiple pharmaceutical companies including GlaxoSmithKline.

W.L., R.S. and H.O. have disclosed that they contributed to the study concept and design; interpretation of the study data; drafting of the manuscript and critical review of the manuscript. They also have disclosed that they are employed by GlaxoSmithKline, the sponsor of this study. H.O. has disclosed that he is a GlaxoSmithKline stockholder.

All investigators were compensated for their time to enroll patients in the study.

Some peer reviewers receive honoraria from CMRO for their review work. The peer reviewers of this paper have disclosed that they have no relevant financial relationships.

Acknowledgments

The authors thank the investigators in the ACCESS study: S. Anderson, L. Bakhtari, P. Barrington, L. DeSantis, K. Devireddy, P. Doghramji, J. Elsen, C. Fields, R. Frank, C. Gordon, J. Hahn, M. Heitbrink, S. Hillis, M. Huynh, N. Katiby, B. Koffman, S. Lasater, A. Miccio, A. Najera, D. Pangtay, S. Pouls, B. Preston, J. Quinn, M. Raikhel, A. Ramayya, C. Ruble, A. Shah, K. Scherberth, M. Swyer, M. Wallace, E. Weidmann, W. Welsh, N. D. Zukkoor, and P. Zumwalt.

The authors also acknowledge the contributions of Dr. Jianmin Wang from RTI International, who supervised the statistical analysis for this study, and Debbie Crozier who provided administrative support to the project.

The data in this paper were previously presented at the American College of Allergy, Asthma & Immunology 2008 Annual Meeting, Seattle, WA, USA, November 6–11 2008.

Notes

† Asthma Control Test is a trademark of QualityMetric, Inc., Lincoln, RI, USA.

† Asthma Control Test is a trademark of QualityMetric, Inc., Lincoln, RI, USA.