RATIONALE: Despite available therapies, previous survey studies reported a prevalence of uncontrolled asthma of 40-60%, depending on the population studied and asthma control measure; however, none have assessed the extent of uncontrolled asthma among the patient population seeking care at respiratory specialist clinics. This study assessed the level of control reported by asthma patients seen in specialists’ offices in the U.S., and among those receiving inhaled corticosteroid (ICS)/long-acting beta-agonist (LABA) therapy.
METHODS: A multi-site, cross-sectional study was conducted between January 21 and April 29, 2019. Asthmatics aged ≥18 years were recruited from 24 pulmonary and allergy clinics. Eligible participants presented to the specialists’ office for a routine or symptomatic visit, had a physician diagnosis of asthma, and used an ICS-containing maintenance medication ≥1 time within the past 4 weeks. Patients with COPD, chronic bronchitis or emphysema were excluded. Patients completed an electronic questionnaire, including the Asthma Control Test (ACT), demographics, medical history, current asthma treatment, healthcare resource use (HRU), and St. George’s Respiratory Questionnaire (SGRQ) to measure quality of life (HRQoL). Asthma control was defined as “Well Controlled” (ACT score ≥20) and “Not Well Controlled” (ACT ≤19). Site-conducted chart abstraction supplemented the surveys.
RESULTS: 774 patients participated in the study; mean (SD) age was 54.5 (16.2) years, 74.2% female. Fifty-three percent (n=410) of patients were not well controlled with a mean ACT score of 14.3 (SD 3.6) vs. 22.4 (SD 1.6) for the Well Controlled group. The Not Well Controlled group scored lower on all 5 ACT questions with the largest differences observed between groups in shortness of breath and nighttime symptoms. Patients with not well controlled asthma reported higher HRU (mean number, and % with ≥1 asthma-related primary care or respiratory specialist visits, emergency department visits, and hospitalizations) and asthma exacerbation rates in the past 12 months, as well as lower HRQoL, compared to those who were well controlled (Table 1). 85% (n=657) of asthma patients seen by specialists received an ICS/LABA therapy in the past 4 weeks. Among asthma patients treated with ICS/LABAs, or low-medium dose or medium-high dose ICS/LABAs, 56.0% (n=368/657), 53.7% (n=220/410), and 58.7% (n=281/479) were not well controlled, respectively.
CONCLUSION: A high level of uncontrolled asthma and associated large disease burden exists among patients receiving care at respiratory specialist clinics in the US, and despite treatment with ICS/LABA combination therapy, highlighting unmet needs in current asthma education, management and/or treatment compliance.
