Associations of patient outcomes with level of asthma control

BACKGROUND

Despite effective medications, asthma remains a significant burden to the US health care system.

OBJECTIVE

To determine whether partly and uncontrolled asthma in respondents to the Asthma Insights and Management (AIM) survey was associated with adverse outcomes (such as visits to health care professionals and medication use) compared with well-controlled asthma.

METHODS

The AIM survey, conducted in 2009, included 2,500 patients with asthma who were 12 years or older. We classified patients into levels of control and compared use of health care services and limitations of activities in patients whose asthma was well controlled vs those with partly and uncontrolled asthma.

RESULTS

Patients who reported lower income and educational status and lacked health insurance were less likely to have had well-controlled asthma. Respondents with uncontrolled asthma were more likely to report ever use of oral steroids (odds ratio [OR], 2.5; 95% confidence interval [CI], 1.9-3.2) and over-the-counter medicine (OR, 2.7; 95% CI, 2.0-3.7) compared with patients whose asthma was well controlled. Respondents with partly and uncontrolled asthma were also significantly more likely to report ever visiting physicians, specialists, or the emergency department or being hospitalized for asthma compared with those whose asthma was well controlled (ORs ranging from 2.1 to 5.6). Finally, respondents whose asthma was uncontrolled had increased odds (ORs ranging from 14 to 34) of reporting that asthma limited their activities compared with respondents whose asthma was well controlled.

CONCLUSION

Patients with partly and uncontrolled asthma defined by international guidelines reported use of significantly more health care resources and greater limitations of their daily activities compared with patients whose asthma was well controlled.

Nonadherence to medical therapy in asthma: risk factors, barriers, and strategies for improving

Asthma is a very prevalent disease in the United States, and the incidence is rising for a variety of reasons. Although progress has been made on several therapeutic fronts, adherence to asthma therapy, particularly controller medications, remains poor. This review of data from the past five years will focus on factors associated with nonadherence, barriers to adherence, factors associated with adherence, and finally strategies for improving. Communication between the health care provider and patient is paramount in improving adherence to medical therapy for asthma and thereby improving control of the disease.