Asthma That Is Not Well-Controlled Is Associated with Increased Healthcare Utilization and Decreased Quality of Life

Abstract

Background. Relationships of asthma control to other asthma outcomes have been incompletely documented. Objective. This study examined the relationship between asthma control and health-related quality of life (HRQL) and subsequent healthcare resource utilization. Methods. A 1-year online prospective longitudinal survey was conducted in 497 adults and 170 children with asthma treated in the past year. Control was measured by Asthma Control Test™ (ACT) and Childhood ACT™ (C-ACT)™ scores dichotomized into “well-controlled” (scores >19) or “not well-controlled” (scores ≤19), and HRQL was measured using the PedsQL™ 3.0 Asthma Module (children) and the SF-12 Health Survey (adults). Multivariate models were used for analysis. Results. HRQL scores were significantly lower for adults (mean decrease 3.4) and children (mean decrease 12.8) whose asthma was not well-controlled compared to patients with well-controlled asthma. Adults with asthma that was not well-controlled at baseline had a threefold greater risk of an asthma-related doctor visit and a 10-fold greater risk of an emergency department (ED) visit for asthma in the subsequent 9 months (odds ratio (OR) = 3.3 and OR = 11.3, respectively). Children with asthma that was not well-controlled had a nearly fivefold increased risk for subsequent asthma-related doctors' and ED visits (OR = 4.8 and OR = 4.9, respectively). Conclusion. Both adults and children with not well-controlled asthma had significantly lower quality of life and were more likely to require an office or ED visit for asthma compared to patients with higher ACT scores. Therefore, it is important to continually assess asthma control and adjust controller therapy accordingly.

• asthma
• healthcare utilization
• quality of life

Acknowledgments

Theresa W. Guilbert, MD—Analysis and interpretation of data and preparation and critical revision of the manuscript. Cindy Garris, MS—Conception and design of the study, analysis and interpretation of data, and preparation and critical revision of the manuscript. Priti Jhingran, PhD—Analysis and interpretation of data and preparation and critical revision of the manuscript. Machaon Bonafede, PhD, MPH—Conception and design of the study, data generation, analysis and interpretation of data, and preparation and critical revision of the manuscript. Kenneth J. Tomaszewski, PhD, MS—Conception and design of the study, analysis and interpretation of data, and preparation and critical revision of the manuscript. Tiffany Bonus, MS—Conception and design of the study, analysis and interpretation of data, and preparation and critical revision of the manuscript. Rebecca Hahn, MPH—Conception and design of the study, data generation, analysis and interpretation of data, and preparation and critical revision of the manuscript. Michael Schatz, MD, MS—Analysis and interpretation of data and preparation and critical revision of the manuscript. Dr. Guilbert has been a consultant for the following pharmaceutical companies: AstraZeneca, GlaxoSmithKline, Genentech/Novartis, Merck/Schering Plough, MAP Pharmaceuticals, and Peerpoint Medical Education Institute. Her institution has received research funding support from Altus Pharmaceuticals, Inspire Pharmaceuticals, and NHLBI. Cindy Garris, MS, and Priti Jhingran, PhD, are employees of GlaxoSmithKline. Michael Schatz, MD, MS, has been an investigator in initiated research grants for the following: Aerocrine, Genentech, GSK, Merck as well as a Research consultant for Amgen and Merck.

Declaration of Interest

The authors report no conflicts of interest. The authors alone are responsible for the content and the writing of the paper.