title: Determinants of future long-term asthma control.
abstract: BACKGROUND
  Asthma control has been hypothesized to be inversely related to asthma severity, directly related to effective management, and also related to other definable factors, but empiric data to support this construct are few.
  
  
  OBJECTIVE
  We sought to identify independent prospective determinants of future long-term asthma control among asthma severity, management, demographic, and comorbidity predictors.
  
  
  METHODS
  Surveys were completed by a random sample of 2250 health maintenance organization members aged 18 to 56 years with persistent asthma. Linked computerized pharmacy data provided baseline and follow-up year medication dispensings. The outcome was follow-up year long-term asthma control, as assessed by using a previously validated 4-level scale based on the number of short-acting beta-agonist canister dispensings.
  
  
  RESULTS
  Oral corticosteroids (odds ratio [OR], 1.9) or unscheduled visits (OR, 1.2) in the prior year, any prior asthma hospitalizations (OR, 1.4), smoking (OR, 2.2), chronic obstructive pulmonary disease (OR, 1.9), male sex (OR, 1.5), black race (OR, 1.3), and lower educational level (OR, 1.1) were independently associated with poorer control in ordinal logistic regression analyses. Regular inhaled corticosteroids (OR, 0.7), long-acting beta-agonists (OR, 0.7) and asthma specialist care (OR, 0.6) were independently associated with better control.
  
  
  CONCLUSIONS
  Markers of asthma severity and other patient characteristics are inversely related to future asthma control, but effective management strategies are associated with improved asthma control, even after accounting for these high-risk characteristics.
  
  
  CONCLUSIONS
  Inhaled corticosteroids, long-acting beta-agonists, and asthma specialist care are associated with improved asthma control, even after accounting for markers of asthma severity.
authors.affiliation: Department of Allergy, Kaiser-Permanente Medical Center, San Diego, CA 92111, USA. michael.x.schatz@kp.org <michael.x.schatz@kp.org>
authors.forename: Michael
authors.initials: M
authors.lastname: Schatz
authors.forename: Robert S
authors.initials: RS
authors.lastname: Zeiger
authors.forename: William M
authors.initials: WM
authors.lastname: Vollmer
authors.forename: David
authors.initials: D
authors.lastname: Mosen
authors.forename: E Francis
authors.initials: EF
authors.lastname: Cook
mesh_terms: D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000318:Adrenergic beta-Agonists / Q000494:pharmacology*; D000328:Adult; D001249:Asthma / Q000188:drug therapy* / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012720:Severity of Illness Index; D013997:Time Factors
chemical_list: D000305:Adrenal Cortex Hormones; D000318:Adrenergic beta-Agonists