Chest
Volume 128, Issue 1, July 2005, Pages 78-84
Journal home page for Chest

Clinical Investigations
Asthma
Control of Asthma Under Specialist Care: Is It Achieved?

https://doi.org/10.1378/chest.128.1.78Get rights and content

Background

The goal of asthma treatment is control of asthma and good quality of life for asthmatic patients; however, many asthmatic patients experience symptoms and limitations.

Study objectives

To examine treatment outcome in asthmatic patients under specialist care.

Design

Multicenter, cross-sectional study.

Setting

Four large outpatient asthma clinics in teaching hospitals in three Greek cities.

Patients

Three hundred seventy-eight randomly selected patients with mild or moderate asthma (265 female patients; mean age, 42.3 years).

Interventions

None.

Measurements and results

Patients completed a questionnaire structured with eight domains covering patient characteristics, drug use at baseline and during exacerbations, regular follow-up, emergency visits, asthma control, symptoms, and limitations. Results show that the majority of patients have symptoms and limitations in their physical and social activities and have frequent exacerbations, while > 40% of patients think that their asthma is not well controlled. Most of our patients receive preventive medication (primarily inhaled corticosteroids, but less so long-acting β2-agonists [LABAs] and leukotriene antagonists), increase their use of medication in case of exacerbations and have regular follow-up. However, the report shows that 48% of patients tried to reduce their medication dose, a fact implying that compliance is not always good.

Conclusions

These data indicate that the goals of asthma treatment are not achieved, even under specialist care. Perhaps more effort should be invested in patient education while an increase in the use of LABAs and leukotriene antagonists, medications that have been shown to prevent exercise-induced bronchoconstriction and improve quality of life, may help better asthma outcomes.

Section snippets

Subjects

Asthmatic patients who participated in the study were a random sample of patients who presented to asthma clinics of four Respiratory Medicine Departments in three large cities in Greece: Athens, Thessaloniki, and Ioannina. The majority of patients reviewed in these clinics come from within and around the above cities where 70% of the Greek population lives, while approximately 10% of the outpatients come from other areas in Greece. All patients (n = 437) who presented to these clinics on

Results

Review of the files and analysis of the questionnaires revealed the following results, which are structured in separate paragraphs. Control of asthma was assessed based on the type and frequency of symptoms, activity limitations, emergency visits, and patients’ perception of control.

Discussion

This report shows that the majority of asthma patients receiving specialist care experience symptoms and limitations in their physical and social activities and that > 40% of patients think that their asthma is not well controlled. In our group of patients, 94% received preventive medication, 78% are aware that they should step-up their use of medication in case of an exacerbation, and 91% reported having undergone spirometry and chest radiography. These data indicate that the goals of asthma

References (34)

  • Global Initiative for Asthma (GINA)

    Global strategy for asthma management and prevention: NHLBI/WHO workshop report

    (2003)
  • P Lagerlov et al.

    Asthma management in five European countries: doctors' knowledge, attitudes and prescribing behaviour

    Eur Respir J

    (2000)
  • T Van der Molen et al.

    Discriminative aspects of two genetic and two asthma-specific instruments: relation with symptoms, bronchodilator use and lung function in patients with mild asthma

    Qual Life Res

    (1997)
  • R de Marco et al.

    ISAYA study group. The control of asthma in Italy: a multicentre descriptive study on young adults with doctor diagnosed current asthma

    Allergy

    (2003)
  • KF Rabe et al.

    Clinical management of asthma in 1999: the asthma Insight and Reality in Europe (AIRE) study

    Eur Respir J

    (2000)
  • LM Osman et al.

    Symptoms, quality of life, and health service contact among young adults with mild asthma

    Am J Respir Crit Care Med

    (2000)
  • ED Bateman et al.

    Is overall asthma control being achieved? A hypothesis-generating study

    Eur Respir J

    (2001)
  • Cited by (39)

    • Serum 25-hydroxyvitamin D, vitamin D supplement and asthma control: The HUNT study

      2018, Respiratory Medicine
      Citation Excerpt :

      Among patients assessed by primary health care physicians in Canada, however, a substantial proportion have uncontrolled asthma (59%) [4]. Even among patients receiving specialist care, almost 50% do not achieve a sufficient level of control [5]. This is unfortunate because people with well controlled asthma can live relatively burden free compared to those with poorly controlled asthma.

    • The Prevalence of Severe Asthma and Low Asthma Control Among Danish Adults

      2014, Journal of Allergy and Clinical Immunology: In Practice
      Citation Excerpt :

      As mentioned earlier in the Discussion, general practice and specialist care is free of charge but referral to specialist care goes through the GP.28 Consequently, the lack of specialist management may be caused by inadequate and rare follow-up visits in general practice, which causes poor assessment of symptoms, rare lung function measurements, and a lack of patient education.9,38,39,41,48 Other contributing factors might be an overestimation of the level of asthma control by GPs and specialists9,39,46,49 but also the well-known tendency among patients with asthma to underestimate their level of asthma symptoms.38,39

    • Costs and health outcomes associated with primary vs secondary care after an asthma-related hospitalization: A population-based study

      2013, Chest
      Citation Excerpt :

      Randomized trials comparing type of care and asthma-related outcomes have been criticized because they facilitated better access to care and education and more intense treatment to the specialist group, showing the practical challenges in the design of randomized experiments in this context.6,9 Among the previous observational studies,4,5,7,8,10,11 the report by Erickson et al10 is the most similar to our study. Compared with subjects who received no specialist visit after a baseline hospitalization, treatment by allergists or pulmonologists was not associated with a reduction in the risk of future ED visits for asthma.

    • Racial Inequities in Asthma Care

      2022, Seminars in Respiratory and Critical Care Medicine
    View all citing articles on Scopus

    This study was supported by an unconditional grant from Merck Sharp and Dohme-Vianex Sa, Athens, Greece.

    View full text