Inducing asthma control key to long-term outcomes

Patients with uncontrolled asthma should receive intensive management and follow-up, say researchers who found that good asthma control at one point in time is associated with increased likelihood for control over the subsequent year.

By contrast, say authors Michael Schatz (Kaiser Permanente Medical Center, San Diego, California, USA) and colleagues, “patients with uncontrolled asthma on an encounter (especially if very poorly controlled) have an increased risk of remaining uncontrolled and of incurring subsequent adverse outcomes, including exacerbations.”

They recommend: “Such patients need a complete management program as recommended by asthma guidelines, which include trigger avoidance, management of comorbidities (including smoking and obesity), optimal step therapy, and attention to inhaler technique and adherence.”

The team surveyed 1267 patients with persistent asthma using the Asthma Control Test at baseline in November 2007, and the following April, July, and October; 782 patients completed all four surveys.

Among the patients who completed all the surveys, 76.2%, 80.4%, and 77.1% of those with well-controlled asthma (score >19) at baseline had well-controlled asthma at each follow-up, respectively. This compared with 33.5%, 36.9%, and 36.0% of patients with uncontrolled asthma (score <19) at baseline.

And, the team say that their results highlight the importance of distinguishing not well-controlled asthma (score 16–19) from very poorly controlled asthma (score <16), with 43.2% to 47.7% of patients in the former group at baseline having good control at follow-up, compared with just 21.7% to 26.7% in the latter group.

When the researchers assessed outcomes between the first follow-up in April and the final follow-up 8 months later, they found that patients who did not have good control at baseline but achieved good control by the first follow-up had no increased risk for exacerbations or short-acting beta₂-agonist (SABA) overuse relative to patients who were well-controlled at both baseline and follow-up.

By contrast, patients who were still not well-controlled by the first follow-up, in particular those who became very poorly controlled, had an increased risk for poor outcomes before the final follow-up.

More encouragingly, however, patients with very poorly controlled asthma at baseline who had well-controlled asthma by the first follow-up did not have an increased risk for poor outcomes during the following 8 months.

“This novel study has shown that the degree of impairment at a point in time establishes the likelihood of achieving well-controlled asthma over the subsequent year,” the authors write in the Journal of Allergy and Clinical Immunology In Practice.

They conclude that future studies will be needed to confirm that “interventions in patients with uncontrolled asthma, especially if very poorly controlled, actually improve asthma control and asthma outcomes over time.”

Licensed from medwireNews with permission from Springer Healthcare Ltd. ©Springer Healthcare Ltd. All rights reserved. Neither of these parties endorse or recommend any commercial products, services, or equipment.