SEATTLE — More than half of adults with asthma who visit their primary care provider for any reason have disease that is not well controlled, indicate findings from a cross-sectional study involving more than 2,200 patients in practices across the United States.
The findings suggest that “primary care providers should probably be taking the opportunity to assess asthma control in all of their asthma patients, regardless of the reason for their visit,” according to the study's lead author, Richard H. Stanford, Pharm.D.
The Asthma Control Characteristics and Prevalence Survey Study was conducted in 35 non-research-based primary care practices in the United States in the first half of 2008. None of the practices had an allergy specialist on staff, Dr. Stanford said at the annual meeting of the American College of Allergy, Asthma, and Immunology.
The 2,238 adult patients (mean age, 47 years) were making scheduled visits and reported having provider-diagnosed asthma and having used asthma medication (including albuterol) in the past year. Patients with chronic obstructive pulmonary disease, chronic bronchitis, or emphysema were excluded. The patient-completed questionnaire included the Asthma Control Test (ACT) and questions about demographics, health behaviors, medical history, asthma exacerbation history, and reason for the visit.
Patients were classified as having asthma that was not well controlled if they had an ACT score less than 20.
The surveyed group was predominantly female (72%); 66% were white, 12% were black, 11% were Hispanic, and 9% were of other races. In all, 40% of patients were visiting their provider for respiratory reasons.
Of those surveyed, 58% had asthma that was not well controlled. The prevalence of uncontrolled asthma was 72% among patients who were visiting for respiratory reasons, but it was also high (48%) among patients visiting for nonrespiratory reasons, noted Dr. Stanford, an investigator with GlaxoSmithKline in Research Triangle Park, N.C.
Within the group visiting for nonrespiratory reasons, blacks were more likely to have asthma that was not well controlled (55%) than were whites (46%) and Hispanics (42%). And not surprisingly, Dr. Stanford noted, the prevalence was high among patients with self-reported severe asthma (82%) and moderate asthma (68%); however, it was also substantial among patients with self-reported mild asthma (31%).
Also within the group visiting for nonrespiratory reasons, compared with their counterparts having controlled asthma, patients having asthma that was not well controlled were more likely to have had an exacerbation, used asthma-related steroids, and made an asthma-related visit to the emergency department or urgent care facility in the past year.
“What was most surprising to us was that among the patients with well-controlled asthma, a fourth of them had had an asthma exacerbation in the previous year,” Dr. Stanford commented.
He noted that the prevalence of asthma that was not well controlled may have been underestimated in the study because the participating primary care practices did not use spirometry.
The study was sponsored by GlaxoSmithKline in collaboration with the Research Triangle Institute.
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