Factors associated with severe uncontrolled asthma and the perception of control by physicians and patients.
BACKGROUND
Despite current treatments, more than half of patients with asthma are not controlled. The objective was to evaluate the correlation between control perceived by patients and physicians, compared with control evaluated according to criteria of the Spanish Guidelines for Asthma Management (GEMA), and to investigate the factors associated with that control.


METHODS
Multicenter, cross-sectional, observational study including 343 patients with severe persistent asthma according to GEMA criteria seen in the Department of Pulmonology and Allergology. The correlation between asthma control perceived by the patient, the physician and according to clinical judgment based on the GEMA criteria was calculated, and a multivariate analysis was used to determine variables related to the perception of asthma control.


RESULTS
According to GEMA criteria, only 10.2% of patients were well controlled, 27.7% had partial control and 62.1% were poorly controlled. Both the physicians and the patients overestimated control: 75.8% and 59.3% of patients had controlled asthma according to the patient and the physician, respectively, and were not controlled according to GEMA (P<.0001). Patients with uncontrolled asthma according GEMA had higher body mass index (P=.006) and physical inactivity (P=.016). Factors associated with a perceived lack of control by both physicians and patients were: nocturnal awakenings (≥ 1 day/week), frequent use of rescue medication (≥ 5 days/week) and significant limitation in activities. Discrepant factors between physicians and patients were dyspnea and emergency room visits (patients only), FEV1 ≤ 80% and a poorer understanding of the disease by the patient (physicians only).


CONCLUSIONS
Only 10% of patients with severe asthma evaluated in this study are controlled according to GEMA criteria. Patients and physicians overestimate control and the overestimation by patients is greater. Physical inactivity and obesity are associated with a lack of control according to GEMA.
Servei de Pneumologia, Hospital Clínic, Universitat de Barcelona, Barcelona, España; Instituto de Investigaciones Biomédicas August Pi i Sunyer (IDIBAPS), Barcelona, España; Centro de Investigaciones Biomédicas en Red de Enfermedades Respiratorias (CIBERES), Barcelona, España. Electronic address: cvennera@clinic.ub.es.
María del Carmen
Mdel C
Vennera
Servei de Pneumologia, Hospital Clínic, Universitat de Barcelona, Barcelona, España; Instituto de Investigaciones Biomédicas August Pi i Sunyer (IDIBAPS), Barcelona, España; Centro de Investigaciones Biomédicas en Red de Enfermedades Respiratorias (CIBERES), Barcelona, España.
César
C
Picado
Novartis Farmacéutica S.A., Barcelona, España.
Lys
L
Herráez
Novartis Farmacéutica S.A., Barcelona, España.
Jordi
J
Galera
Novartis Farmacéutica S.A., Barcelona, España.
Jordi
J
Casafont
D001249:Asthma / Q000188:drug therapy*; D001291:Attitude of Health Personnel; D001294:Attitude to Health; D003430:Cross-Sectional Studies; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D008875:Middle Aged; D010820:Physicians; D017410:Practice Guidelines as Topic; D012720:Severity of Illness Index
Asma; Asthma; Control; Factores de riesgo; Guía española para el manejo del asma; Pacientes; Patients; Risk factors; Spanish guidelines for asthma management