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Karadoğan D, Yılmazel Uçar E, Yavuz Y, Baccioglu A, Öztürk AB, Bozkurt N, Kavas M, Karaoğlanoğlu S, Çelik G. Characteristics of asthma in an older adult population according to sex and control level: why are asthma symptoms in older women not well-controlled? J Asthma 2024; 61:539-549. [PMID: 38060588 DOI: 10.1080/02770903.2023.2293062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 12/03/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVE The older adult population in Turkey has increased by 22.6% in the last 5 years, and the characteristics of such patients with asthma remain uninvestigated. Therefore, we aimed to evaluate the characteristics of older adults with asthma according to sex and asthma control status to provide an in-depth overview of asthma in this population in Turkey. METHODS The data of older adults (age 65 years and over) with asthma were obtained from a multicenter, cross-sectional asthma database registry (Turkish Adult Asthma Registry, TAAR) funded by the Turkish Thoracic Society. Comparisons were made based on sex and asthma control levels using the Global Initiative for Asthma (GINA) Asthma Symptom Control Questionnaire. RESULTS Of the 2053 (11.5%) patients registered with the TAAR, 227 were older adults (median age, 69 (8), women, 75.8% (n = 172)). Of these, 46.5% (n = 101) had obesity to some degree. Compared with men, women had lower education, income levels, and employment rates. Additionally, women exhibited a higher prevalence of obesity, hypertension, and thyroid gland disease than men. Being female (OR: 2.99; 95% CI: 1.307-6.880), the presence of gastroesophageal reflux disease (OR: 2.855; 95% CI: 1.330-6.130), and a predicted forced expiratory volume in the first-second value lower than 80% (OR: 2.938; 95% CI: 1.451-5.948) were associated with poorly controlled asthma. CONCLUSIONS Herein, older adults comprised 11.5% of adult patients with asthma. Being female poses a disadvantage in terms of both asthma prevalence and control in the older adult asthmatic population owing to the prevalence of comorbidities and socioeconomic sex-related distinguishing factors.
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Affiliation(s)
- Dilek Karadoğan
- Department of Chest Diseases, School of Medicine, Recep Tayyip Erdoğan University, Rize, Turkey
| | - Elif Yılmazel Uçar
- Department of Pulmonary Disease, Faculty of Medicine, Ataturk University, Erzurum, Turkey
| | - Yasemin Yavuz
- Department of Biostatistics and Informatics, Ankara University School of Medicine, Ankara, Turkey
| | - Ayse Baccioglu
- Department of Pulmonary Disease, Faculty of Medicine, Kirikkale University, Kirikkale, Turkey
| | - Ayşe Bilge Öztürk
- Department of Allergy and Immunology, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | - Nurgül Bozkurt
- Department of Chest Diseases, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Murat Kavas
- Department of Immunology and Allergy, University of Health Sciences Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, İstanbul, Turkey
| | - Selen Karaoğlanoğlu
- Department of Pulmonology, Ordu University, Training and Research Hospital, Ordu, Turkey
| | - Gülfem Çelik
- Department of Chest Disease, Division of Immunology and Allergy, Ankara University School of Medicine, Ankara, Turkey
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Chuang YC, Tsai HH, Lin MC, Wu CC, Lin YC, Wang TN. Cluster analysis of phenotypes, job exposure, and inflammatory patterns in elderly and nonelderly asthma patients. Allergol Int 2024; 73:214-223. [PMID: 38290901 DOI: 10.1016/j.alit.2024.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 12/03/2023] [Accepted: 12/17/2023] [Indexed: 02/01/2024] Open
Abstract
BACKGROUND Asthma has been identified as different phenotypes due to various risk factors. Age differences may have potential effects on asthma phenotypes. Our study aimed to identify potential asthma phenotypes among adults divided by age as either younger or older than 65 years. We also compared differences in blood granulocyte patterns, occupational asthmagens, and asthma control-related outcomes among patient phenotype clusters. METHODS We recruited nonelderly (<65 years old) (n = 726) and elderly adults (≥65 years old) (n = 201) with mild-to-severe asthma. We conducted a factor analysis to select 17 variables. A two-step cluster analysis was used to classify subjects with asthma phenotypes, and a discriminant analysis was used to verify the classification of cluster results. RESULTS There were three clusters with different characteristics identified in both the nonelderly and elderly asthmatic adults. In the nonelderly patient group, cluster 2 (obese, neutrophilic phenotypes) had a 1.85-fold significantly increased risk of asthma exacerbations. Cluster 3 (early-onset, atopy, and smoker with an eosinophil-predominant pattern) had a 2.37-fold risk of asthma exacerbations and higher oral corticosteroid (OCS) use than cluster 1 (late-onset and LMW exposure with paucigranulocytic blood pattern). Among elderly patients, cluster 2 had poor lung function and more ex-smokers. Cluster 3 (early-onset, long asthma duration) had the lowest paucigranulocytic blood pattern percentages in the elderly group. CONCLUSIONS The novelty of the clusters was found in age-dependent clusters. We identified three distinct phenotypes with heterogeneous characteristics, asthma exacerbations and medicine use in nonelderly and elderly asthmatic patients, respectively. Classification of age-stratified asthma phenotypes may lead to precise identification of patients, which provides personalized disease management.
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Affiliation(s)
- Yung-Chi Chuang
- Department of Public Health, College of Health Science, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hsin-Hua Tsai
- Department of Public Health, College of Health Science, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Meng-Chih Lin
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chao-Chien Wu
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yuan-Chung Lin
- Institute of Environmental Engineering, National Sun Yat-Sen University, Kaohsiung, Taiwan
| | - Tsu-Nai Wang
- Department of Public Health, College of Health Science, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
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Celik GE, Aydin O, Gokmen D, Koycu Buhari G, Celebi Sozener Z, Gemicioglu B, Bulut I, Beyaz S, Orcen C, Ozdemir SK, Keren M, Damadoglu E, Yakut T, Kalpaklioglu AF, Baccioglu A, Yalim SA, Yilmaz I, Koca Kalkan I, Uysal MA, Ozgun Niksarlioglu EY, Kalyoncu AF, Karakaya G, Erbay M, Nayci S, Tepetam FM, Gelincik AA, Dirol H, Goksel O, Karaoglanoglu S, Oner Erkekol F, Isik SR, Yildiz F, Yavuz Y, Karadogan D, Bozkurt N, Seker U, Oguzulgen IK, Basyigit I, Baris SA, Yilmazel Ucar E, Erdogan T, Polatli M, Ediger D, Gunaydin FE, Turk M, Pur L, Katran ZY, Sekibag Y, Aykac EF, Mungan D, Gul O, Cengiz A, Akkurt B, Ozden S, Demir S, Unal D, Aslan AF, Can A, Gumusburun R, Bogatekin G, Akten HS, Inan S, Erdinc M, Ogus AC, Kavas M, Polat Yulug D, Cakmak ME, Kaya SB, Alpagat G, Ozgur ES, Uzun O, Tas Gulen S, Pekbak G, Kizilirmak D, Havlucu Y, Donmez H, Arslan B, Cetin GP, Soyyigit S, Kara BY, Pasaoglu Karakis G, Dursun AB, Kendirlinan R, Ozturk AB, Sevinc C, Omeroglu Simsek G, Abadoglu O, Cerci P, Yucel T, Yorulmaz I, Tezcaner ZC, Tatar EC, Suslu AE, Ozer S, Dursun E, Yorgancioglu A. Picturing asthma in Turkey: results from the Turkish adult asthma registry. J Asthma 2023; 60:1973-1986. [PMID: 37096963 DOI: 10.1080/02770903.2023.2206902] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 04/10/2023] [Accepted: 04/20/2023] [Indexed: 04/26/2023]
Abstract
INTRODUCTION National data on asthma characteristics and the factors associated with uncontrolled asthma seem to be necessary for every country. For this purpose, we developed the Turkish Adult Asthma Registry for patients with asthma aiming to take a snapshot of our patients, thereby assigning the unmet needs and niche areas of intervention. METHODS Case entries were performed between March 2018 and March 2022. A web-based application was used to record data. Study outcomes were demographic features, disease characteristics, asthma control levels, and phenotypes. RESULTS The registry included 2053 patients from 36 study centers in Turkey. Female subjects dominated the group (n = 1535, 74.8%). The majority of the patients had allergic (n = 1158, 65.3%) and eosinophilic (n = 1174, 57.2%) asthma. Six hundred nineteen (32.2%) of the patients had obese asthma. Severe asthma existed in 670 (32.6%) patients. Majority of cases were on step 3-5 treatment (n: 1525; 88.1%). Uncontrolled asthma was associated with low educational level, severe asthma attacks in the last year, low FEV1, existence of chronic rhinosinusitis and living in particular regions. CONCLUSION The picture of this registry showed a dominancy of middle-aged obese women with moderate-to-severe asthma. We also determined particular strategic targets such as low educational level, severe asthma attacks, low FEV1, and chronic rhinosinusitis to decrease uncontrolled asthma in our country. Moreover, some regional strategies may also be needed as uncontrolled asthma is higher in certain regions. We believe that these data will guide authorities to reestablish national asthma programs to improve asthma service delivery.
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Affiliation(s)
- Gulfem Elif Celik
- Department of Chest Disease, Division of Immunology and Allergy, Ankara University School of Medicine, Ankara, Turkey
| | - Omur Aydin
- Department of Chest Disease, Division of Immunology and Allergy, Ankara University School of Medicine, Ankara, Turkey
| | - Derya Gokmen
- Department of Biostatistics and Informatics, Ankara University School of Medicine, Ankara, Turkey
| | - Gozde Koycu Buhari
- Department of Immunology and Allergy, University of Health Sciences, Ankara Ataturk Sanatoryum Training and Research Hospital, Ankara, Turkey
| | - Zeynep Celebi Sozener
- Department of Chest Disease, Division of Immunology and Allergy, Ankara University School of Medicine, Ankara, Turkey
- Ankara City Hospital Clinic of Immunology and Allergic Diseases, Ankara, Turkey
| | - Bilun Gemicioglu
- Cerrahpaşa Faculty of Medicine, Department of Pulmonary Diseases, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Ismet Bulut
- Department of Immunology and Allergy, University of Health Sciences Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Sengul Beyaz
- Ankara City Hospital Clinic of Immunology and Allergic Diseases, Ankara, Turkey
- Istanbul Faculty of Medicine, Department of Internal Medicine, Division of Immunology and Allergic Diseases, Istanbul University, Istanbul, Turkey
| | - Cihan Orcen
- Clinic of Allergy and Immunology, University of Health Sciences, Kocaeli Derince Training and Research Hospital, Kocaeli, Turkey
| | - Secil Kepil Ozdemir
- Department of Chest Diseases, Division of Allergy and Immunology, University of Health Sciences, Dr. Suat Seren Chest Diseases and Surgery Training and Research Hospital, Izmir, Turkey
| | - Metin Keren
- Department of Immunology and Allergy, University of Health Sciences Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Ebru Damadoglu
- Faculty of Medicine, Department of Chest Diseases, Division of Allergy and Clinical Immunology, Hacettepe University, Ankara, Turkey
| | - Tugce Yakut
- Clinic of Immunology and Allergic Diseases, Diyarbakir Gazi Yasargil Training and Research Hospital, Diyarbakır, Turkey
| | - Ayse Fusun Kalpaklioglu
- Faculty of Medicine, Department of Allergy and Immunology, Kirikkale University, Kirikkale, Turkey
| | - Ayse Baccioglu
- Faculty of Medicine, Department of Allergy and Immunology, Kirikkale University, Kirikkale, Turkey
| | - Sumeyra Alan Yalim
- Faculty of Medicine, Department of Allergy and Immunology, Kirikkale University, Kirikkale, Turkey
| | - Insu Yilmaz
- School of Medicine, Department of Chest Diseases, Division of Allergy and Immunology, Erciyes University, Kayseri, Turkey
| | - Ilkay Koca Kalkan
- Department of Immunology and Allergy, University of Health Sciences, Ankara Ataturk Sanatoryum Training and Research Hospital, Ankara, Turkey
| | - Mehmet Atilla Uysal
- Department of Chest Diseases, University of Health Sciences, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Elif Yelda Ozgun Niksarlioglu
- Department of Chest Diseases, University of Health Sciences, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Ali Fuat Kalyoncu
- Faculty of Medicine, Department of Chest Diseases, Division of Allergy and Clinical Immunology, Hacettepe University, Ankara, Turkey
| | - Gul Karakaya
- Faculty of Medicine, Department of Chest Diseases, Division of Allergy and Clinical Immunology, Hacettepe University, Ankara, Turkey
| | - Muge Erbay
- Clinic of Immunology and Allergy Diseases, Mehmet Akif Inan Training and Research Hospital, Sanliurfa, Turkey
| | - Sibel Nayci
- Faculty of Medicine, Department of Chest Diseases, Mersin University, Mersin, Turkey
| | - Fatma Merve Tepetam
- Department of Immunology and Allergy, University of Health Sciences Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Asli Akkor Gelincik
- Istanbul Faculty of Medicine, Department of Internal Medicine, Division of Immunology and Allergic Diseases, Istanbul University, Istanbul, Turkey
| | - Hulya Dirol
- Faculty of Medicine, Department of Chest Diseases, Akdeniz University, Antalya, Turkey
| | - Ozlem Goksel
- Faculty of Medicine, Pulmonary, Immunology and Allergy, Ege University, Izmir, Turkey
| | - Selen Karaoglanoglu
- Department of Pulmonology, Ordu University, Training and Research Hospital, Ordu, Turkey
| | - Ferda Oner Erkekol
- Faculty of Medicine, Ankara City Hospital, Clinic of Immunology and Allergic Diseases, Ankara Yildirim Beyazit University, Ankara, Turkey
- Division of Allergy and Immunology, Medicana International Ankara Hospital, Ankara, Turkey
| | - Sacide Rana Isik
- Adult Allergy and Immunology Department, American Hospital, Istanbul, Turkey
| | - Fusun Yildiz
- Faculty of Medicine, Department of Pulmonary Diseases, Kocaeli University, Kocaeli, Turkey
- School of Medicine, Department of Pulmonary Diseases, Cyprus Internatıonal Unıversıty, Cyprus
| | - Yasemin Yavuz
- Department of Biostatistics and Informatics, Ankara University School of Medicine, Ankara, Turkey
| | - Dilek Karadogan
- School of Medicine, Department of Chest Diseases, Recep Tayyip Erdoğan University, Rize, Turkey
| | - Nurgul Bozkurt
- Faculty of Medicine, Department of Chest Diseases, Akdeniz University, Antalya, Turkey
| | - Ummuhan Seker
- Clinic of Immunology and Allergic Diseases, Bursa City Hospital, Bursa, Turkey
| | | | - Ilknur Basyigit
- Faculty of Medicine, Department of Pulmonary Diseases, Kocaeli University, Kocaeli, Turkey
| | - Serap Argun Baris
- Faculty of Medicine, Department of Pulmonary Diseases, Kocaeli University, Kocaeli, Turkey
| | - Elif Yilmazel Ucar
- Faculty of Medicine, Department of Pulmonary Disease, Ataturk University, Erzurum, Turkey
| | - Tuba Erdogan
- Faculty of Medicine, Department of Internal Medicine, Division of Immunology and Allergy, Baskent University, Ankara, Turkey
| | - Mehmet Polatli
- School of Medicine, Department of Pulmonology, Aydin Adnan Menderes University, Aydin, Turkey
| | - Dane Ediger
- Faculty of Medicine, Department of Chest Diseases, Division of Immunology and Allergy, Bursa Uludag University, Bursa, Turkey
| | - Fatma Esra Gunaydin
- Faculty of Medicine, Department of Chest Diseases, Division of Immunology and Allergy, Bursa Uludag University, Bursa, Turkey
| | - Murat Turk
- School of Medicine, Department of Chest Diseases, Division of Allergy and Immunology, Erciyes University, Kayseri, Turkey
- Clinic of Immunologic and Allergic Diseases, Kayseri City Hospital, Kayseri, Turkey
| | - Leyla Pur
- Adult Allergy Service, Glenfield Hospital, University Hospitals of Leicester, Leicester, UK
| | - Zeynep Yegin Katran
- Department of Immunology and Allergy, University of Health Sciences Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Yonca Sekibag
- Cerrahpaşa Faculty of Medicine, Department of Pulmonary Diseases, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Enes Furkan Aykac
- Cerrahpaşa Faculty of Medicine, Department of Pulmonary Diseases, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Dilsad Mungan
- Department of Chest Disease, Division of Immunology and Allergy, Ankara University School of Medicine, Ankara, Turkey
| | - Ozcan Gul
- Department of Chest Disease, Division of Immunology and Allergy, Ankara University School of Medicine, Ankara, Turkey
| | - Ali Cengiz
- Department of Chest Disease, Division of Immunology and Allergy, Ankara University School of Medicine, Ankara, Turkey
| | - Bulent Akkurt
- Department of Chest Diseases, Division of Allergy and Immunology, University of Health Sciences, Dr. Suat Seren Chest Diseases and Surgery Training and Research Hospital, Izmir, Turkey
| | - Seyma Ozden
- Department of Immunology and Allergy, University of Health Sciences Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Semra Demir
- Istanbul Faculty of Medicine, Department of Internal Medicine, Division of Immunology and Allergic Diseases, Istanbul University, Istanbul, Turkey
| | - Derya Unal
- Istanbul Faculty of Medicine, Department of Internal Medicine, Division of Immunology and Allergic Diseases, Istanbul University, Istanbul, Turkey
| | - Ayse Feyza Aslan
- Istanbul Faculty of Medicine, Department of Internal Medicine, Division of Immunology and Allergic Diseases, Istanbul University, Istanbul, Turkey
| | - Ali Can
- Istanbul Faculty of Medicine, Department of Internal Medicine, Division of Immunology and Allergic Diseases, Istanbul University, Istanbul, Turkey
| | - Reyhan Gumusburun
- Faculty of Medicine, Pulmonary, Immunology and Allergy, Ege University, Izmir, Turkey
| | - Gulhan Bogatekin
- Faculty of Medicine, Pulmonary, Immunology and Allergy, Ege University, Izmir, Turkey
| | - Hatice Serpil Akten
- Faculty of Medicine, Pulmonary, Immunology and Allergy, Ege University, Izmir, Turkey
| | - Sinem Inan
- Faculty of Medicine, Pulmonary, Immunology and Allergy, Ege University, Izmir, Turkey
| | - Munevver Erdinc
- Faculty of Medicine, Department of Pulmonology, Ege University, Izmir, Turkey
| | - Aliye Candan Ogus
- Faculty of Medicine, Department of Chest Diseases, Akdeniz University, Antalya, Turkey
| | - Murat Kavas
- Department of Immunology and Allergy, University of Health Sciences Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Demet Polat Yulug
- Clinic of Chest Diseases, Mersin City Training and Research Hospital, Mersin, Turkey
| | - Mehmet Erdem Cakmak
- Faculty of Medicine, Department of Chest Diseases, Division of Allergy and Clinical Immunology, Hacettepe University, Ankara, Turkey
| | - Saltuk Bugra Kaya
- Faculty of Medicine, Department of Chest Diseases, Division of Allergy and Clinical Immunology, Hacettepe University, Ankara, Turkey
| | - Gulistan Alpagat
- Faculty of Medicine, Department of Allergy and Immunology, Kirikkale University, Kirikkale, Turkey
| | - Eylem Sercan Ozgur
- Faculty of Medicine, Department of Chest Diseases, Mersin University, Mersin, Turkey
| | - Oguz Uzun
- Department of Pulmonary Medicine, Ondokuz Mayis University, Samsun, Turkey
| | - Sule Tas Gulen
- School of Medicine, Department of Pulmonology, Aydin Adnan Menderes University, Aydin, Turkey
| | - Gulseren Pekbak
- Faculty of Medicine, Department of Chest Diseases, Division of Immunology and Allergy, Bursa Uludag University, Bursa, Turkey
| | - Deniz Kizilirmak
- Faculty of Medicine, Department of Pulmonology, Manisa Celal Bayar University, Manisa, Turkey
| | - Yavuz Havlucu
- Faculty of Medicine, Department of Pulmonology, Manisa Celal Bayar University, Manisa, Turkey
| | - Halil Donmez
- School of Medicine, Department of Chest Diseases, Division of Allergy and Immunology, Recep Tayyip Erdogan University, Rize, Turkey
| | - Bahar Arslan
- School of Medicine, Department of Chest Diseases, Division of Allergy and Immunology, Erciyes University, Kayseri, Turkey
| | - Gulden Pacaci Cetin
- School of Medicine, Department of Chest Diseases, Division of Allergy and Immunology, Erciyes University, Kayseri, Turkey
| | - Sadan Soyyigit
- Faculty of Medicine, Ankara City Hospital, Clinic of Immunology and Allergic Diseases, Ankara Yildirim Beyazit University, Ankara, Turkey
| | - Bilge Yilmaz Kara
- School of Medicine, Department of Chest Diseases, Recep Tayyip Erdoğan University, Rize, Turkey
| | - Gulden Pasaoglu Karakis
- School of Medicine, Department of Chest Diseases, Adult Allergy-Immunology Unit, Biruni University, Istanbul, Turkey
| | - Adile Berna Dursun
- School of Medicine, Department of Chest Diseases, Division of Allergy and Immunology, Recep Tayyip Erdogan University, Rize, Turkey
- Medical School, Department of Respiratory Medicine, Lokman Hekim University, Ankara, Turkey
| | - Resat Kendirlinan
- Clinic of Immunology and Allergic Diseases, Izmir Katip Celebi University, Ataturk Training and Research Hospital, Izmir, Turkey
| | - Ayse Bilge Ozturk
- Faculty of Medicine, Department of Allergy and Immunology, Medeniyet University, Istanbul, Turkey
| | - Can Sevinc
- School of Medicine, Department of Respiratory Diseases, Dokuz Eylul University, Izmir, Turkey
| | - Gokcen Omeroglu Simsek
- School of Medicine, Department of Respiratory Diseases, Dokuz Eylul University, Izmir, Turkey
| | | | - Pamir Cerci
- Clinic of Immunology and Allergic Diseases, Van Regional Training and Research Hospital, Van, Turkey
| | - Taskin Yucel
- School of Medicine Department of Ear Nose and Throat, Hacettepe University, Ankara, Turkey
| | - Irfan Yorulmaz
- School of Medicine, Department of Otolaryngology-Head and Neck Surgery, Ankara University, Ankara, Turkey
| | - Zahide Ciler Tezcaner
- School of Medicine, Department of Otolaryngology-Head and Neck Surgery, Ankara University, Ankara, Turkey
| | - Emel Cadalli Tatar
- Department of Otolaryngology, University of Health Sciences, Etlik City Hospital, Ankara, Turkey
| | - Ahmet Emre Suslu
- School of Medicine Department of Ear Nose and Throat, Hacettepe University, Ankara, Turkey
- Ahmet Emre Suslu Private Ear Nose and Throat Clinic, Ankara, Turkey
| | - Serdar Ozer
- School of Medicine Department of Ear Nose and Throat, Hacettepe University, Ankara, Turkey
| | - Engin Dursun
- Faculty of Medicine, Department of Otorhinolaryngology, Lokman Hekim University, Ankara, Turkey
| | - Arzu Yorgancioglu
- Faculty of Medicine, Department of Pulmonology, Manisa Celal Bayar University, Manisa, Turkey
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Vinnikov D, Raushanova A, Mukatova I, Nurpeissov T, Кushekbayeva A, Toxarina A, Yessimova B, Bespayeva F, Brimkulov N. Asthma control in Kazakhstan: need for urgent action. BMC Pulm Med 2023; 23:7. [PMID: 36611130 PMCID: PMC9826583 DOI: 10.1186/s12890-022-02287-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 12/15/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Asthma control, patients' awareness level and adherence to treatment in Kazakhstan have never been studied. The aim of this study was to verify the prevalence of controlled, poorly controlled and uncontrolled asthma in a large sample of three largest cities of Kazakhstan. METHODS We recruited 600 (median age 54 (interquartile range (IQR) 22) years, 64% females) patients with diagnosis confirmed earlier in the outpatient facilities in Almaty, Astana and Shymkent in 2020-2021. We offered a structured questionnaire on asthma control and risk factors as of GINA and performed spirometry. We report the prevalence of asthma control, knowledge and skills and pharmacological treatment with 95% confidence interval (CI) and the association of selected predictors with asthma control. RESULTS With the median of 9 (IQR 13) years of diagnosis, 40% of patients had comorbid COPD and 42% had allergic rhinitis, whereas 32% lived with pets. Asthma was well-controlled in only 12.3% (95% CI 9.7-15.0), partly controlled in 29.8% (95% CI 26.2-33.5) and uncontrolled in 57.8% (95% CI 53.9-61.8) patients. ACQ-5 score (range 0-5.8, median 2) equaled 0.2 (IQR 0.85) in well-controlled asthma patients, 1.4 (IQR 1) in partly controlled and 2.8 (IQR 1.4) in uncontrolled asthma patients. Knowledge and skills levels were very low. Only 54% were on inhaled corticosteroids (52.2% of them used budesonide/formoterol and 39.5% used fluticasone/salmeterol). 39% used steroids per os or parenterally within a period of 12 months (51% of patients with uncontrolled asthma). CONCLUSION Asthma control, knowledge and skills levels of asthma patients in the largest cities of Kazakhstan remain unacceptably low, whereas pharmacological treatment is far from optimal. Urgent action should be taken to support doctors' training, and we call to launch a national asthma program to coordinate asthma care in Kazakhstan.
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Affiliation(s)
- Denis Vinnikov
- grid.77184.3d0000 0000 8887 5266Al-Farabi Kazakh National University, 71 Al-Farabi Avenue, 050040 Almaty, Kazakhstan ,grid.77642.300000 0004 0645 517XPeoples’ Friendship University of Russia (RUDN University), Moscow, Russian Federation
| | - Aizhan Raushanova
- grid.77184.3d0000 0000 8887 5266Al-Farabi Kazakh National University, 71 Al-Farabi Avenue, 050040 Almaty, Kazakhstan
| | | | - Tair Nurpeissov
- grid.443453.10000 0004 0387 8740Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan
| | - Assia Кushekbayeva
- grid.443628.f0000 0004 1799 358XSouth-Kazakhstan Medical Academy, Shymkent, Kazakhstan
| | | | - Baktygul Yessimova
- grid.443453.10000 0004 0387 8740Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan
| | | | - Nurlan Brimkulov
- grid.444253.00000 0004 0382 8137Kyrgyz State Medical Academy, Bishkek, Kyrgyzstan
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Akca Sumengen A, Ocakci AF. Evaluation of the effect of an education program using cartoons and comics on disease management in children with asthma: a randomized controlled study. J Asthma 2023; 60:11-23. [PMID: 35175171 DOI: 10.1080/02770903.2022.2043358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The aim of this study was to determine the effect of an education program, the Health Promotion Program for Children with Asthma (HPPCA), on disease control and quality of life in children aged between 7 and 11 and diagnosed with asthma. The program was developed using cartoons and color-in materials and was based on the health promotion model developed by Nola J. Pender and brain-based learning theories. MATERIALS AND METHODS The sample of the study consisted of 74 children between the ages of 7 and 11 who presented to the respiratory diseases' unit of a university hospital in Istanbul. All participants were given basic asthma education by their physicians, and were then randomly assigned to a group that received the HPPCA program or a control group that received no further education. After the HPPCA education was applied to the experimental group alone, both groups were administered two post-tests as a follow-up and retest at the end of the first and fourth month after the intervention. The standardized Sociodemographic Question Form, the Childhood Asthma Control Test (C-ACT) and the Pediatric Asthma Quality of Life Questionnaire (PAQLQ) were used for the follow-up. RESULTS The asthma control and quality of life scores of the children included in the experimental group were found to be significantly higher compared to the control group at the first- and fourth-month follow-ups (p<.001). The rate of school absenteeism decreased significantly in children who received HPPCA education at the first follow-up compared to the children who did not receive the education (p<.05). PRACTICE IMPLICATIONS The present study found that the HPPCA education, whose design was based on the health promotion model, and which was supported by cartoons in order to attract the attention of the children, was effective. The HPPCA was proven to create a sense of control over asthma and to improve the quality of life in the children. It is recommended that there be an asthma nurse in pediatric allergy and immunology outpatient clinics who can specifically provide an HPPCA. Further studies should be conducted to demonstrate the effectiveness of this program, which was examined in the present study for the first time with a randomized controlled method.HighlightsAsthma control is extremely important for the quality of life in children with asthma.Asthma education provided to school-age children yields the best results when new teaching techniques and multimedia content are used.Asthma education for children must be based on a good theoretical methodology.Children can best manage asthma when they learn about it directly.Asthma education conducted according to the guidelines is of great importance during the COVID-19 pandemic.
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Affiliation(s)
- Aylin Akca Sumengen
- Koc University Graduate School of Health Science, İstanbul, Turkey.,Yeditepe University Faculty of Health Science, Atesehir/Istanbul, Turkey
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Yorgancıoğlu A, Aksu K, Naycı SA, Ediger D, Mungan D, Gül U, Beekman MJHI. Short-acting β 2-agonist prescription patterns in patients with asthma in Turkey: results from SABINA III. BMC Pulm Med 2022; 22:216. [PMID: 35655251 PMCID: PMC9161536 DOI: 10.1186/s12890-022-02008-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 04/28/2022] [Indexed: 11/10/2022] Open
Abstract
Background Over-reliance on short-acting β2-agonists (SABAs) is associated with poor asthma outcomes. However, the extent of SABA use in Turkey is unclear owing to a lack of comprehensive healthcare databases. Here, we describe the demographics, disease characteristics and treatment patterns from the Turkish cohort of the SABA use IN Asthma (SABINA) III study. Methods This observational, cross-sectional study included patients aged ≥ 12 years with asthma from 24 centres across Turkey. Data on sociodemographics, disease characteristics and asthma treatments were collected using electronic case report forms. Patients were classified by investigator-defined asthma severity (guided by the 2017 Global Initiative for Asthma [GINA]) and practice type (primary/specialist care). The primary objective was to describe SABA prescription patterns in the 12 months prior to the study visit. Results Overall, 579 patients were included (mean age [standard deviation; SD]: 47.4 [16.1] years; 74.3% female), all of whom were treated by specialists. Most patients had moderate-to-severe asthma (82.7%, GINA steps 3–5), were overweight or obese (70.5%), had high school or university/post-graduate education (51.8%) and reported fully reimbursed healthcare (97.1%). The mean (SD) asthma duration was 12.0 (9.9) years. Asthma was partly controlled/uncontrolled in 56.3% of patients, and 46.5% experienced ≥ 1 severe exacerbation in the preceding 12 months. Overall, 23.9% of patients were prescribed ≥ 3 SABA canisters in the previous 12 months (considered over-prescription); 42.9% received no SABA prescriptions. As few patients had mild asthma, only 5.7% were prescribed SABA monotherapy. Therefore, most patients (61.5%) were prescribed SABA in addition to maintenance therapy, with 42.8% receiving ≥ 3 SABA canisters in the previous 12 months. Inhaled corticosteroids (ICS), ICS + a long-acting β-agonist fixed-dose combination and oral corticosteroids were prescribed to 14.5%, 88.3% and 28.5% of all patients, respectively. Additionally, 10.2% of patients purchased SABA over the counter, of whom 27.1% purchased ≥ 3 canisters in the preceding 12 months. Conclusions Despite all patients being treated by specialists and most receiving fully reimbursed healthcare, nearly a quarter of patients received prescriptions for ≥ 3 SABA canisters in the previous 12 months. This highlights a public health concern and emphasizes the need to align clinical practices with the latest evidence-based recommendations. Supplementary Information The online version contains supplementary material available at 10.1186/s12890-022-02008-9.
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Affiliation(s)
- Arzu Yorgancıoğlu
- Department of Pulmonology, Faculty of Medicine, Manisa Celal Bayar University, Manisa, Turkey.
| | - Kurtuluş Aksu
- Division of Immunology and Allergy, Department of Chest Diseases, University of Health Sciences Atatürk Chest Diseases and Chest Surgery Education and Research Hospital, Ankara, Turkey
| | - Sibel Atış Naycı
- Department of Pulmonology, Faculty of Medicine, Mersin University, Mersin, Turkey
| | - Dane Ediger
- Division of Allergy and Immunology, Department of Pulmonology, Faculty of Medicine, Bursa Uludağ University, Bursa, Turkey
| | - Dilşad Mungan
- Department of Pulmonology, Division of Allergy and Immunology, Faculty of Medicine, Ankara University, Ankara, Turkey
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Zhang Y, Huang L. Characteristics of older adult hospitalized patients with bronchial asthma: a retrospective study. Allergy Asthma Clin Immunol 2021; 17:122. [PMID: 34861886 PMCID: PMC8641253 DOI: 10.1186/s13223-021-00628-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Accepted: 11/18/2021] [Indexed: 11/10/2022] Open
Abstract
Background Bronchial asthma is a chronic inflammation of the airways. Older adult patients with bronchial asthma are defined as patients older than 65 and with a previous or current clear diagnosis of asthma. The purpose of this study was to determine the characteristics of older adult hospitalized patients with bronchial asthma. Methods We retrospectively analyzed the data from patients with bronchial asthma admitted to the General Hospital of the Northern Theater Command from September 2018 to January 2020. We divided them into the older adult (≥ 65 years) and the younger (< 65 years) groups. We compared the clinical and epidemiological characteristics of the two groups. Results There were 181 inpatients with bronchial asthma, including 41 older adult patients, accounting for 22.7%. There were significant differences in age, sex, smoking, duration of disease, age at diagnosis of asthma, hospital stays, hospitalization costs, number of acute attacks 1 year before admission, number of hospitalizations in our hospital one year before admission, asthma control test score, forced expiratory volume in 1 s (FEV1), FEV1/FVC, the severity of acute attacks, comorbidities, and inhaled corticosteroid dose between the two groups. There were many older adult patients with asthma (mostly late-onset asthma). The hospitalization costs were high. Most patients had many comorbidities, poor asthma control, severe attack, and heavy economic burdens. Conclusion Attention should be focused on achieving asthma control in older adult patients to improve their quality of life and reduce their economic burdens.
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Albertson TE, Pugashetti JV, Chau-Etchepare F, Chenoweth JA, Murin S. Pharmacotherapeutic management of asthma in the elderly patient. Expert Opin Pharmacother 2020; 21:1991-2010. [PMID: 32686969 DOI: 10.1080/14656566.2020.1795131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Asthma is a heterogeneous syndrome with variable phenotypes. Reversible airway obstruction and airway hyper-responsiveness often with an atopic or eosinophilic component is common in the elderly asthmatic. Asthma chronic obstructive pulmonary disease overlap syndrome (ACOS), a combination of atopy-mediated airway hyper-responsiveness and a history of smoking or other environmental noxious exposures, can lead to some fixed airway obstruction and is also common in elderly patients. Little specific data exist for the treating the elderly asthmatic, thus requiring the clinician to extrapolate from general adult data and asthma treatment guidelines. AREAS COVERED A stepwise approach to pharmacotherapy of the elderly patient with asthma and ACOS is offered and the literature supporting the use of each class of drugs reviewed. EXPERT OPINION Inhaled, long-acting bronchodilators in combination with inhaled corticosteroids represent the backbone of treatment for the elderly patient with asthma or ACOS . Beyond these medications used as direct bronchodilators and topical anti-inflammatory agents, a stepwise approach to escalation of therapy includes multiple options such as oral leukotriene receptor antagonist or 5-lipoxygense inhibitor therapy, oral phosphodiesterase inhibitors, systemic corticosteroids, oral macrolide antibiotics and if evidence of eosinophilic/atopic component disease exists then modifying monoclonal antibody therapies.
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Affiliation(s)
- Timothy E Albertson
- Department of Internal Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, School of Medicine, U. C. Davis , Sacramento, CA, USA.,Department of Emergency Medicine, School of Medicine, U. C. Davis , Sacramento, CA, USA.,Department of Medicine, Veterans Administration Northern California Health Care System , Mather, CA, USA
| | - Janelle V Pugashetti
- Department of Internal Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, School of Medicine, U. C. Davis , Sacramento, CA, USA.,Department of Medicine, Veterans Administration Northern California Health Care System , Mather, CA, USA
| | - Florence Chau-Etchepare
- Department of Internal Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, School of Medicine, U. C. Davis , Sacramento, CA, USA.,Department of Medicine, Veterans Administration Northern California Health Care System , Mather, CA, USA
| | - James A Chenoweth
- Department of Emergency Medicine, School of Medicine, U. C. Davis , Sacramento, CA, USA.,Department of Medicine, Veterans Administration Northern California Health Care System , Mather, CA, USA
| | - Susan Murin
- Department of Internal Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, School of Medicine, U. C. Davis , Sacramento, CA, USA.,Department of Medicine, Veterans Administration Northern California Health Care System , Mather, CA, USA
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Yorgancıoğlu AA, Gemicioğlu B, Cingi C, Kalaycı Ö, Kalyoncu AF, Bachert C, Hellings P, Pfaar O, Schünemann HJ, Wallace D, Bedbrook A, Czarlewski W, Bousquet J. ARIA 2019, Allerjik Rinite Tedavi Yaklaşımı-Türkiye. Turk Thorac J 2020; 21:122-133. [PMID: 32203003 DOI: 10.5152/turkthoracj.2019.19084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 08/06/2019] [Indexed: 11/22/2022]
Abstract
Gerçek yaşamda, çevresel maruziyetlerin de etkilediği rinit ve astım mültimorbidite durumlarında, dijitalleşmiş ve kişiye odaklanan tedaviler için bütünleştirilmiş tedavi yollarının değerlendirilmesi önerilmektedir. Gerçek yaşamdaki bu durum mültisipliner bir yaklaşımla basamaklandırılıp, rehberilerinde ülkelerdeki gereksinimlere göre değiştilmesini gerektirebilir. Allerjik rinitte hem farmakoterapi hem immünoterapi açısından acil yeni yaklaşımlara ihtiyaç olduğu görülmüştür. 3. Aralık 2018'de Paris'te bir toplantı yapılmış ve iki ayrı belge hazırlanmıştır. Bu yayında bunlara ait bir özet sunulup, ülkeye ve sağlık sistemine uygun kullanımın çerçevesi oluşturulmak istenmiştir.
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Affiliation(s)
| | - Bilun Gemicioğlu
- Department of Chest Diseases, İstanbul University-Cerrahpaşa, Cerrahpasa School of Medicine, İstanbul, Turkey
| | - Cemal Cingi
- Department of Ear Nose Throat, Eskişehir Osmangazi University School of Medicine, Eskişehir, Turkey
| | - Ömer Kalaycı
- Department of Pediatric Allergy, Hacettepe University School of Medicine, Ankara, Turkey
| | - Ali Fuat Kalyoncu
- Department of Chest Diseases, Hacettepe University School of Medicine, Ankara, Turkey
| | - Claus Bachert
- Upper Airways Research Laboratory, ENT Dept, Ghent University Hospital, Ghent, Belgium
| | - Peter Hellings
- Department of Otorhinolaryngology, University Hospitals Leuven, Belgium, and Academic Medical Center, University of Amsterdam, The Netherlands and Euforea, Brussels, Belgium
| | - Oliver Pfaar
- Department of Otorhinolaryngology, Head and Neck Surgery, Section of Rhinology and Allergy, University Hospital Marburg, Phillipps-Universität Marburg, Germany
| | - Holger J Schünemann
- Department of Health Research Methods, Evidence, and Impact, Division of Immunology and Allergy, McMaster University, Hamilton, ON, Canada
| | - Dana Wallace
- Nova Southeastern University, Fort Lauderdale, Florida, USA
| | - Anna Bedbrook
- MACVIA-France, Fondation partenariale FMC VIA-LR, Montpellier, France
| | | | - Jean Bousquet
- MACVIA-France, Fondation partenariale FMC VIA-LR, Montpellier, France
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Gemicioğlu B, Mungan D, Bavbek S, Yıldız F, Polatlı M, Naycı S, Erkekol FÖ, Türker H, Günen H, Çamsarı G, Abadoğlu Ö, Çımrın A, Dursun AB, Göksel Ö, Özdemir SK, Börekci Ş, Aydın Ö, Ocaklı B, Gür A, Baygul A, Mısırlıgil Z. Validity and Reliability of the Assessment Tool for Asthma (ATA) Questionnaire: the ATA Study. Turk Thorac J 2020; 21:93-99. [PMID: 32202998 DOI: 10.5152/turkthoracj.2019.180186] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Accepted: 02/14/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVES A multicenter trial was designed to validate the "Assessment Tools for Asthma (ATA)" questionnaire, a newly developed questionnaire, which evaluates both asthma control and risk factors associated with asthma control with a single instrument. MATERIALS AND METHODS This cross-sectional study involved 810 cases from 14 clinics in 9 Turkish cities. The ATA questionnaire and Asthma Control Test (ACT) were administered. The Visual Analog Scale (VAS) was used to evaluate the control status of 100 randomized cases. ATA is an eight-item physician-administered questionnaire. It comprises the following two sections-ATA1, assesses symptomatic control criteria, and the remaining section, queries the flare-up of asthma, control of comorbidities, treatment adherence, and inhaler technique. RESULTS The mean scores for ATA1, ATA total, VAS, and ACT were 24.7±14.8, 53.8±19, 7.1±3, and 18.8±5.5, respectively. According to the ATA questionnaire, among all patients, 34.3% had controlled, 18.8% had partly controlled, and 46.9% had uncontrolled asthma. Furthermore, 16.6% patients had flare-ups between visits, 96.4% patients had uncontrolled comorbidity, 17% patients had irregular asthma treatment, and only 8.4% patients used the incorrect inhaler technique. The ATA questionnaire showed internal consistency (Cronbach's alpha coefficient=0.683). ACT, ATA1, and two specialists' evaluations using VAS correlated strongly with the ATA total scores (Spearman correlation coefficient (r) values: 0.776, 0.783, and 0.909, respectively; p-values: p<0.001, p<0.001, and p<0.001, respectively). According to Receiver Operating Characteristic analysis, the cut-off value of ATA was 50 (sensitivity=84.4%, specificity=82.40%). CONCLUSION The validated ATA questionnaire may be a practical tool for physicians in asthma management.
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Affiliation(s)
- Bilun Gemicioğlu
- Department of Pulmonary Diseases, İstanbul University-Cerrahpaşa, Cerrahpaşa School of Medicine, İstanbul, Turkey
| | - Dilşad Mungan
- Department of Pulmonary Diseases, Division of Allerrgy and Immunology, Ankara University School of Medicine, Ankara, Turkey
| | - Sevim Bavbek
- Department of Pulmonary Diseases, Division of Allerrgy and Immunology, Ankara University School of Medicine, Ankara, Turkey
| | - Füsun Yıldız
- Department of Pulmonary Diseases, Kocaeli University School of Medicine, Kocaeli, Turkey
| | - Mehmet Polatlı
- Department of Pulmonary Diseases, Adnan Menderes University School of Medicine, Aydın, Turkey
| | - Sibel Naycı
- Department of Pulmonary Diseases, Mersin University School of Medicine, Mersin, Turkey
| | - Ferda Öner Erkekol
- Ataturk Chest Diseases and Thoracic Surgery Education and Research Hospital, Ankara, Turkey
| | - Hatice Türker
- Süreyyapasa Chest Diseases and Thoracic Surgery Education and Research Hospital, İstanbul, Turkey
| | - Hakan Günen
- Süreyyapasa Chest Diseases and Thoracic Surgery Education and Research Hospital, İstanbul, Turkey
| | - Güngor Çamsarı
- Yedikule Chest Diseases and Thoracic Surgery Education and Research Hospital, İstanbul, Turkey
| | - Öznur Abadoğlu
- Department of Pulmonary Diseases, Cumhuriyet University School of Medicine, Sivas, Turkey
| | - Arif Çımrın
- Department of Pulmonary Diseases, Dokuz Eylül University School of Medicine, İzmir, Turkey
| | - A Berna Dursun
- Department of Internal Medicine, Division of Allergy and Immunology, Recep Tayip Erdoğan University School of Medicine, Rize, Turkey
| | - Özlem Göksel
- Department of Pulmonary Diseases, Division of Allerrgy and Immunology, Ege University School of Medicine, İzmir, Turkey
| | | | - Şermin Börekci
- Department of Pulmonary Diseases, İstanbul University-Cerrahpaşa, Cerrahpaşa School of Medicine, İstanbul, Turkey
| | - Ömür Aydın
- Department of Pulmonary Diseases, Division of Allerrgy and Immunology, Ankara University School of Medicine, Ankara, Turkey
| | - Birsen Ocaklı
- Süreyyapasa Chest Diseases and Thoracic Surgery Education and Research Hospital, İstanbul, Turkey
| | - Aygün Gür
- Yedikule Chest Diseases and Thoracic Surgery Education and Research Hospital, İstanbul, Turkey
| | - Arzu Baygul
- Department of Biostatistics, Beykent University, İstanbul, Turkey
| | - Zeynep Mısırlıgil
- Department of Pulmonary Diseases, Division of Allerrgy and Immunology, Ankara University School of Medicine, Ankara, Turkey
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Tomisa G, Horváth A, Szalai Z, Müller V, Tamási L. Prevalence and impact of risk factors for poor asthma outcomes in a large, specialist-managed patient cohort: a real-life study. J Asthma Allergy 2019; 12:297-307. [PMID: 31576150 PMCID: PMC6768014 DOI: 10.2147/jaa.s211246] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 07/02/2019] [Indexed: 12/12/2022] Open
Abstract
Background Risk factors for poor asthma outcomes may have considerable influence on the control level and medical care of asthmatic patients. Our objective was to conduct a study that provides data on the level of symptom control and the frequency of specific risk factors for poor asthma outcomes on a large patient cohort. Methods A cross-sectional, non-interventional real-life study was conducted among asthmatic patients treated by respiratory specialists in Hungary. Asthma control and risk factor assessment were done according to Global Initiative for Asthma guideline (Box 2–2). In the data analysis, phase descriptive statistics, graphical outputs, and Fisher’s exact tests were used. Results Of 12743 patients enrolled by 187 specialists, asthma was well controlled in 36.0%, partially controlled in 29.29%, and uncontrolled in 34.71% of the cases. The most common comorbidities were rhinitis/sinusitis (66.84%), cardiovascular diseases (43.81%), and gastroesophageal reflux disease (20.11%). The following risk factors had the strongest relationship with uncontrolled disease: incorrect inhaler technique causing side effects (odds ratio, OR 4.86, 3.51–6.8), previous severe exacerbation (OR 4.79, 4.02–5.72), high short-acting beta agonist (SABA) use (OR 4.46, 4.03–4.93), incorrect inhaler technique associated with an exacerbation (OR 3.91, 3.06–5.03), and persistently low forced expiratory volume in 1 s (FEV1, OR 3.14, 2.8–3.52). The most frequent risk factors were smoking (OR 1.47, 1.36–1.59) and obesity (OR 1.34, 1.24–1.45). Furthermore, high loss of control was associated with an initial low FEV1 (OR 2.21, 2.01–2.44), frequent oral corticosteroid (OCS) use (OR 1.83, 1.64–2.05), poor adherence to treatment (OR 2.51, 2.21–2.86), and allergen exposure (OR 1.63, 1.47–1.81). Conclusions This study indicated that the presence of risk factors for poor asthma outcomes listed by the Global Initiative for Asthma document significantly influenced actual control level in a real-world large patient cohort, with high SABA use, previous severe exacerbation, incorrect inhaler technique, persistently low FEV1, and poor adherence to treatment having the highest impact.
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Affiliation(s)
- Gábor Tomisa
- Department of Pulmonology, Semmelweis University, Budapest 1125, Hungary.,Chiesi Hungary Ltd, Budapest 1138, Hungary
| | - Alpár Horváth
- Department of Pulmonology, Semmelweis University, Budapest 1125, Hungary.,Chiesi Hungary Ltd, Budapest 1138, Hungary
| | | | - Veronika Müller
- Department of Pulmonology, Semmelweis University, Budapest 1125, Hungary
| | - Lilla Tamási
- Department of Pulmonology, Semmelweis University, Budapest 1125, Hungary
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Air Pollution/Irritants, Asthma Control, and Health-Related Quality of Life among 9/11-Exposed Individuals with Asthma. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16111924. [PMID: 31151302 PMCID: PMC6604324 DOI: 10.3390/ijerph16111924] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 05/23/2019] [Accepted: 05/25/2019] [Indexed: 12/27/2022]
Abstract
Asthma control is suboptimal among World Trade Center Health Registry (WTCHR) enrollees. Air pollution/irritants have been reported as the most prevalent trigger among World Trade Center responders. We examined the relationship between air pollution/irritants and asthma control. We also evaluated the association of asthma control with health-related quality of life (HRQoL). We included 6202 enrollees age ≥18 with a history of asthma who completed the WTCHR asthma survey between 2015 and 2016. Based on modified National Asthma Education and Prevention Program criteria, asthma was categorized as controlled, poorly-controlled, or very poorly-controlled. HRQoL indicators include ≥14 unhealthy days, ≥14 activity limitation days, and self-rated general health. We used multinomial logistic regression for asthma control, and unconditional logistic regression for HRQoL, adjusting for covariates. Overall, 27.1% had poorly-controlled and 32.2% had very poorly-controlled asthma. Air pollution/irritants were associated with poorly-controlled (adjusted odds ratio (AOR) = 1.70; 95% CI = 1.45–1.99) and very poorly-controlled asthma (AOR = 2.15; 95% CI = 1.83–2.53). Poor asthma control in turn worsened the HRQoL of asthmatic patients. Very poorly-controlled asthma was significantly associated with ≥14 unhealthy days (AOR = 3.60; 95% CI = 3.02–4.30), ≥14 activity limitation days (AOR = 4.37; 95% CI = 3.48–5.50), and poor/fair general health status (AOR = 4.92; 95% CI = 4.11–5.89). Minimizing World Trade Center (WTC) asthmatic patients’ exposure to air pollution/irritants may improve their disease management and overall well-being.
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