Determinants of asthma control in tertiary level in Turkey: a cross-sectional multicenter survey.
OBJECTIVE
Recent data demonstrate that control of asthma is far from optimal worldwide. The aim of this study was to evaluate the level of asthma control in tertiary health services by the use of Asthma Control Test (ACT) and to assess the factors which might influence the control of the disease.


METHODS
A total of 2336 patients with asthma were recruited from 28 tertiary hospitals in the study. Asthma severity was classified by the frequency of asthma symptoms, pulmonary function tests, and medication requirements according to asthma guidelines. The level of asthma control was assessed by the Turkish version of ACT and determinants of asthma control were evaluated with medical history, physical examination, patients' and disease characteristics.


RESULTS
Due to missing data, 1188 subjects' records were evaluated. Nearly half of the patients (51.5%) were found to be "controlled" (ACT > or =20) and 48.5% was defined as "uncontrolled" (ACT < 20). The ratio of uncontrolled asthmatic patients was significantly higher in severe asthmatics than in mild and moderate asthmatics (p < .01). Female sex, education below secondary level, forced expiratory volume in one second (FEV(1)) value <80%, peak expiratory flow (PEF) value <80%, hospitalization/emergency department visits in the last year, and systemic steroid use were found to be significantly associated with inadequate control (p < .01).


CONCLUSIONS
This study demonstrated that asthma control was still inadequate in the tertiary level although overall control was better than previous reports in Turkey. Patients with severe asthma were more likely to have uncontrolled disease; worse asthma control was also associated with increased hospitalizations and emergency care admissions.
Turktas
Haluk
H
Gazi University, School Of Medicine, Department of Chest Diseases, Ankara, Turkey.
Mungan
Dilsad
D
Uysal
Mehmet Atilla
MA
Oguzulgen
Kivilcim
K
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D018927:Anti-Asthmatic Agents / Q000008:administration & dosage*; D001249:Asthma / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology*; D016009:Chi-Square Distribution; D003430:Cross-Sectional Studies; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D019538:Health Care Surveys; D006779:Hospitals, Public; D006801:Humans; D008297:Male; D008875:Middle Aged; D020380:Needs Assessment; D016011:Normal Distribution; D010349:Patient Compliance / Q000706:statistics & numerical data; D011336:Probability; D012016:Reference Values; D012129:Respiratory Function Tests; D018570:Risk Assessment; D012720:Severity of Illness Index; D012737:Sex Factors; D011795:Surveys and Questionnaires; D055512:Tertiary Prevention / Q000379:methods / Q000706:statistics & numerical data*; D016896:Treatment Outcome; D014421:Turkey / Q000453:epidemiology; D055815:Young Adult
D018927:Anti-Asthmatic Agents