Investigation of factors associated with difficult-to-control asthma.
OBJECTIVE
To determine the prevalence of factors associated with difficult-to-control asthma.


METHODS
Patients with severe asthma were selected from the outpatient asthma clinic of the Ribeirão Preto School of Medicine Hospital das Clínicas. The patients were divided into two groups: controlled severe asthma and difficult-to-control severe asthma. After new attempts to optimize the severe asthma treatment, a questionnaire was applied, and additional tests for factors associated with difficult-to-control asthma, such as environmental and occupational exposure, smoking history, social factors, rhinitis/sinusitis, gastroesophageal reflux disease (GERD), obstructive sleep apnea, congestive heart failure (CHF), pulmonary embolism, cystic fibrosis, vocal cord dysfunction, alpha-1 antitrypsin deficiency, and Churg-Strauss syndrome, were performed.


RESULTS
77 patients with severe asthma were selected, of which 47 suffered from hard-to-control asthma, being 68.1% female, with mean age of 44.4 years (+/-14.4), and forced expiratory volume in one second of 54.7% (+/-18.3). The most factors most often associated with difficult-to-control asthma were noncompliance with treatment (68%), rhinitis/sinusitis (57%), GERD (49%), environmental exposure (34%), occupational exposure (17%), smoking history (10%), obstructive sleep apnea (2%), and CHF (2%). At least one of these factors was identified in every case.


CONCLUSIONS
Noncompliance with treatment was the factor most often associated with difficult-to-control asthma, underscoring the need to investigate comorbidities in the evaluation of patients with this form of the disease.
Araujo
Ana Carla Sousa de
AC
Department of Clinical Medicine, Faculdade de Medicina de Ribeiro Preto da Universidade de São Paulo - FMRP/USP, Universityof São Paulo at Ribeirão Preto School of Medicine - Ribeirão Preto (SP) Brazil.
Ferraz
Erica
E
Borges
Marcos de Carvalho
Mde C
Filho
João Terra
JT
Vianna
Elcio Oliveira
EO
D000328:Adult; D000465:Algorithms; D001249:Asthma / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000209:etiology*; D001938:Brazil / Q000453:epidemiology; D004781:Environmental Exposure / Q000009:adverse effects / Q000706:statistics & numerical data; D004812:Epidemiologic Methods; D005260:Female; D005764:Gastroesophageal Reflux / Q000175:diagnosis; D005938:Glucocorticoids / Q000627:therapeutic use; D006333:Heart Failure / Q000150:complications; D006801:Humans; D008297:Male; D016273:Occupational Exposure / Q000009:adverse effects / Q000706:statistics & numerical data; D012307:Risk Factors; D012852:Sinusitis / Q000150:complications; D012882:Skin Tests; D020181:Sleep Apnea, Obstructive / Q000150:complications; D012907:Smoking / Q000009:adverse effects; D017211:Treatment Failure; D016312:Treatment Refusal / Q000706:statistics & numerical data
D005938:Glucocorticoids