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Eur Respir J 2007, doi:10.1183/09031936.00039707
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ORIGINAL ARTICLE |
Sub-optimal asthma control: prevalence, detection and consequences in primary practice
1 University of Toronto, Toronto, Ontario, Canada
2 Université Laval, Quebec City, Quebec, Canada
3 GlaxoSmithKline Canada Inc., Mississauga, Ontario, Canada
* To whom correspondence should be addressed. E-mail: kchapman{at}ca.inter.net.
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Abstract |
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Telephone surveys describing sub-optimal asthma control may be biased by low response rates.
To obtain an unbiased assessment of asthma control and assess its impact in primary care.
Primary practitioners used a one page control questionnaire in 50 consecutive asthma patients.
Of 10,428 patients assessed by 354 physicians, 59% were uncontrolled, 19% well-controlled and 23% totally controlled. Physicians overestimated control, regarding only 42% of patients as uncontrolled. Physicians were more likely to report plans to alter the regimens of uncontrolled patients than controlled patients (1.29 versus 0.20 medication changes per patient, p<0.01) doing so in a fashion consistent with guideline recommendations. Of uncontrolled patients, 59% required one or more urgent care or specialist visits versus 26% of well-controlled and 15% of totally controlled patients. Patients were more likely to report short term symptom control when they had not required urgent or specialist care (OR 5.68; 95% CI 4.91–6.58).
The majority of asthma patients treated in primary practice are uncontrolled. Lack of control can be recognized by physicians who are likely to consider appropriate changes to therapy. A lack of short term symptom control of asthma is associated with excess health care utilization.
Keywords: Guideline dissemination, health care utilization
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