Determinants associated with uncontrolled asthma in Portugal: A national population-based study

Risk Factors Associated with Asthma Control and Quality of Life in Patients with Mild Asthma Without Preventer Treatment, a Cross-Sectional Study

Purpose

To study risk factors for uncontrolled asthma and insufficient quality of life (QoL) in patients with mild asthma, ie those without preventer treatment.

Patients and Methods

Patients aged 18-75 years with a doctor's diagnosis of asthma randomly selected from primary and secondary care in Sweden. Mild asthma was defined as self-reported current asthma and no preventer treatment. Data were collected from self-completed questionnaires in 2012 and 2015. Well-controlled asthma was defined as Asthma Control Test (ACT) ≥20 points and no exacerbation and uncontrolled asthma as ACT<20 points and/or at least one exacerbation in the previous six months. QoL was measured by the Mini Asthma Quality of Life Questionnaire (Mini-AQLQ), where a total mean score of ≥ 6 indicated sufficient and < 6 insufficient QoL. Multivariate logistic regression analyses were performed using asthma control and Mini-AQLQ as dependent variables. Asthma control was dichotomized as controlled and uncontrolled asthma and the Mini-AQLQ as sufficient QoL (mean score ≥6) and insufficient QoL (mean score <6).

Results

Among 298 patients, 26% had uncontrolled asthma, 40% insufficient QoL and 20% both uncontrolled asthma and insufficient QoL. Age ≥60 years, obesity, daily smoking, rhinitis and inadequate knowledge of asthma self-management were independently associated with poor asthma control. Factors independently associated with insufficient QoL were age ≥60 years, overweight, obesity, rhinitis, sinusitis and inadequate knowledge of asthma self-management. Age ≥60 years, obesity, rhinitis and inadequate knowledge of asthma self-management were independently associated with both uncontrolled asthma and insufficient QoL.

Conclusion

Among asthma patients without preventer medication, 26% had uncontrolled asthma and 40% had insufficient asthma-related QoL. Older age, obesity, and rhinitis were risk factors for both poor asthma control and a reduced QoL, but having good knowledge of asthma self-management reduced this risk. Our findings suggest that this group of patients requires further attention and follow-up.

Adherence, Disease Control, and Misconceptions Related to the Use of Inhalation Therapy in Patients with Obstructive Pulmonary Diseases: A Cross-Sectional Study

Background and Objectives: Inadequate treatment of asthma and chronic obstructive pulmonary disease (COPD) might have a negative impact on their progression. Inhalation therapy is the cornerstone of pharmacotherapy for these conditions. However, challenges such as low adherence, negative attitudes, and misconceptions about inhaled medications still persist, impeding effective disease management. This study aimed to evaluate adherence, ascertain the level of disease control in asthma and COPD, explore potential misconceptions surrounding inhalation therapy among patients with obstructive lung diseases and the general population in Vojvodina, and evaluate the reliability of newly developed questionnaires employed in the study. Materials and Methods: This cross-sectional study utilized a battery of questionnaires encompassing sociodemographic data, the Asthma Control Test (ACT), the COPD Assessment Test (CAT), along with two novel questionnaires-one for assessing adherence and another for analyzing attitudes toward inhalation therapy. Statistical analyses were conducted using SPSS software, version 25.0. Results: The average ACT score among patients with asthma was 17.31, while it was 19.09 for the CAT questionnaire among COPD patients. The composite score on the newly developed adherence assessment questionnaire was 2.27, exhibiting a reliability coefficient lower than recommended (α = 0.468). Significant statistical differences emerged among sample subgroups regarding attitudes and misconceptions toward inhalation therapy. The reliability coefficient for this questionnaire was deemed satisfactory (α = 0.767). Conclusions: Adherence rates were notably suboptimal in both subgroups of the studied population. The disease control levels were higher among asthma patients, while they exhibited less prevalent misconceptions regarding inhalation therapy compared to COPD patients and the healthy population.

Cost-effectiveness analysis of house dust mite allergen immunotherapy in children with allergic asthma

BACKGROUND

Cost-effectiveness studies evaluating allergen immunotherapy (AIT) in children are limited but needed to drive clinical and policy-making decisions such as reimbursement of new interventions. In this study, we compared the cost effectiveness of subcutaneous (SCIT) and sublingual immunotherapy (SLIT) tablets to the standard of care (SOC) treatment in children with house dust mite-driven (HDM) allergic asthma.

METHODS

We developed a hypothetical Markov model based on the Global Initiative for Asthma (GINA) severity steps to compare the three strategies over a 10-year horizon divided by cycles of 6 months. SOC was used as a reference to calculate the incremental cost-effectiveness ratio (ICER). Deterministic and probabilistic sensitivity analyses were used to assess models' uncertainty. Other scenarios were evaluated to strengthen the presentation of results.

RESULTS

The ICER for SCIT and SLIT tablets was 1281€ and 7717€, respectively. The cost-effectiveness threshold for Portugal was 18,482.80€; both treatment approaches were below this limit. The major contributors to these results were the AIT effects on reducing moderate and severe exacerbations and asthma controller medication. In the sensitivity analysis, SCIT revealed a higher probability of cost-effectiveness than SLIT. When including allergic rhinitis as comorbidity, ICER values reduced markedly, especially for SCIT intervention.

CONCLUSIONS

AIT was cost effective in children with HDM-driven allergic asthma, especially when given by the subcutaneous route. The high probability of cost effectiveness, especially for SCIT, may drive future policy decisions and AIT-prescribing habits. AIT adherence greatly influenced the results highlighting the value of implementing strategies to promote adherence rates.

Uncontrolled Asthma Determinants In Overweight And Obese Adults

Relevance of the research — epidemiological and clinical studies in recent years confirmed the existence of a bronchial asthma (BA) phenotype associated with obesity. In the current literature, obesity is considered a possible risk factor for the development of BA. Nonetheless, the factors contributing to the uncontrolled course of BA among overweight patients need to be elucidated. The need for a personalized approach to patient management is reflected in the latest edition of the international consensus document on the asthma treatment – GINA (Global Initiative for Asthma: Global Strategy for Asthma Management and Prevention). Despite substantial number of epidemiological studies on the prevalence of BA in obese patients, the threshold values of major risk factors for the development of uncontrolled BA (vitamin D, IL-17, IL-10, BMI; intake of total fat, carbohydrates and cholesterol) remain unclear. Objective: to identify the risk of developing an uncontrolled course of BA depending on the levels of IL-17, IL-10 and vitamin D; dietary characteristics (intake of total fat, cholesterol and carbohydrates); and body mass index (BMI). Material and methods — The study involved 79 patients with an established diagnosis of BA, 18-69 years old. Patients were split among three groups according to their BMI values. Group I included 27 patients with normal body weight (BMI: 18.5-24.9 kg/m2), 56 (42-61) years of age. Group II comprised 28 overweight patients (BMI: 25-30 kg/m2), 57 (50.5-63.5) years of age; Group III encompassed 24 obese patients (BMI≥30 kg/m2), 58 (54-65) years of age. Results — the risk of developing uncontrolled BA increased by 1.8 times with increase of a total fat intake (95% CI: 1.28-2.72; p=0.001); by 5.7 times with BMI>26.7 kg/m2 (95% CI:2.05-15.92; p<0.001); by 5.2 times with IL-17 level >83.5 pg/mL (95% CI:1.71-15.8; p=0.003); by 8.32 times with vitamin D content <24.5 ng/mL (95% CI: 2.9-23.72; p<0.001). Conclusion — patients with BMI>26.7 kg/m2, vitamin D deficiency (i.e., vitamin D content <24.5 ng/mL), IL-17 content >83.5 pg/mL, as well as excessive consumption of total fat, carbohydrates and cholesterol, could be attributed to the risk group for developing an uncontrolled BA.