PHILADELPHIA — Most asthma patients are not well controlled on their current therapy, contrary to what they may believe or tell their physicians, Laura Sutton, Pharm.D., reported in a poster at the annual meeting of the American College of Allergy, Asthma, and Immunology.
In a recent survey of adult asthma patients, 61% reported moderately or poorly controlled symptoms, although almost half of that group rated their asthma as being well controlled, said Dr. Sutton, manager of clinical development, GlaxoSmithKline.
She and her colleagues administered a survey to 1,306 adult asthma patients who were taking prescription medication for their disease. The participants completed a medical history questionnaire and the 5-item Asthma Control Test and answered additional questions about the impact of asthma on their lives and their concerns about their illness.
On the Asthma Control Test, 39% of patients scored 20 or higher, indicating that their asthma was well or completely controlled clinically, and 61% scored 19 or lower, indicating that their asthma was moderately or poorly controlled. But 30% of those in the moderately/poorly controlled group believed that their asthma was controlled, despite their low scores on the test.
In patients in the moderately/poorly controlled group, the perception of having controlled asthma varied among treatments: 40% of those on montelukast (with or without a short-acting β-agonist) thought their condition was controlled, as did 39% of those on inhaled corticosteroids and 50% of those on a short-acting β-agonist alone. Those with moderately/poorly controlled asthma reported significantly more disruptions and worry in their daily lives. “[They] are constantly aware of their disease and try to avoid triggers. … They also feel less satisfied with life.”
Nevertheless, 56% of those with controlled asthma and 28% of those with moderately/poorly controlled asthma still said their symptoms were not severe enough to warrant medication on a daily basis.
The survey findings highlight the disconnect between clinical symptoms and patient perceptions, Dr. Sutton said in an interview. “Many patients learn to cope with frequent asthma symptoms or adapt their lifestyle to accommodate their asthma, not understanding what the goals are for well-controlled asthma. That's why it is so important to monitor asthma control [and to talk] with a health care provider if a patient continues to experience symptoms on his or her current medication.”
Five Questions to a Quick Assessment
The Asthma Control Test is a quick and easy way to obtain a reliable assessment of asthma control under a patient's current treatment plan, Dr. Sutton said.
The five questions in the test are based on measures of asthma control established by the National Institutes of Health. Scores range from 5 to 25, with higher scores indicating better control of the disease and lower scores indicating poor or moderate control (5–14 is deemed “poorly controlled”; 15–19, “moderately controlled”; and 20–25, “under control”). The test includes the following questions:
▸ In the past 4 weeks, how much of the time did your asthma keep you from getting as much done at work, school, or at home?
▸ During the past 4 weeks, how often have you had shortness of breath?
▸ During the past 4 weeks, how often did your asthma symptoms (wheezing, coughing, shortness of breath, chest tightness, or pain) wake you up at night or earlier than usual in the morning?
▸ During the past 4 weeks, how often have you used your rescue inhaler or nebulizer medication?
▸ How would you rate your asthma control during the past 4 weeks?
The Asthma Control Test takes less than 1 minute to complete and is available in English and Spanish, for adults and children. It can be accessed online at