Reality and understanding of asthma control.
The aim of this study was to describe the level and perception of control in severe asthma in Trinidad after the introduction of revised guidelines for asthma management. Adult asthmatics (N = 329) at Trinidad's chest clinics were cross-sectionally examined for guideline-defined disease control. Patients' mean (SD) age was 54.36 (14.9) years, with body mass index = 28.54 (7.4) kg/meter(2), and females were proportionally more (246, 74.74%). Measured (45.29%) and perceived (18.96%) uncontrolled disease were poorly concordant (κ statistic = 0.197). Co-morbidity (≥2 conditions) correlated with uncontrolled disease in 55.80% of patients (Spearman correlation p = 0.03). Absolute peak expiratory flow was higher (p < 0.001) in controlled and/or partially controlled disease than in uncontrolled asthma. Routine work limitation, night-time disturbances, work absenteeism, exacerbations, rescue inhalation and perceived control correlated with uncontrolled asthma (p < 0.001). Few patients self-monitored lung function (9.73%) or kept an asthma diary (6.69%), but 65.1% believed they had to live with their symptoms. The asthma burden was at least one hospitalization (53.80%) and emergency department visit (66.36%) in the past year, cough (74.49%), dyspnoea (84.50%), wheezing (80.55%) and chest tightness (66.87%). After the revised guidelines, uncontrolled asthma and related morbidity remain suboptimal, with disagreeing actual and perceived control. Efforts to transform guidelines into patient care with realistic interpretation of control are recommended.
Department of Paraclinical Sciences, The University of the West Indies, St Augustine, Trinidad.
Stephen
S
Beharry
Department of Paraclinical Sciences, The University of the West Indies, St Augustine, Trinidad.
David
D
Gidla
Department of Paraclinical Sciences, The University of the West Indies, St Augustine, Trinidad.
Anitra
A
Maharaj
Department of Paraclinical Sciences, The University of the West Indies, St Augustine, Trinidad.
Satesh
S
Bisram
Department of Medicine, Faculty of Medical Sciences, The University of the West Indies, St Augustine, Trinidad.
Sateesh
S
Sakhamuri
Department of Medicine, Faculty of Medical Sciences, The University of the West Indies, St Augustine, Trinidad.
Terence A
TA
Seemungal
Department of Paraclinical Sciences, The University of the West Indies, St Augustine, Trinidad lexleyp@gmail.com.
Lexley M
LM
Pinto Pereira
D000041:Absenteeism; D000328:Adult; D000368:Aged; D018927:Anti-Asthmatic Agents / Q000627:therapeutic use*; D001249:Asthma / Q000150:complications / Q000188:drug therapy* / Q000523:psychology; D003371:Cough / Q000209:etiology; D003430:Cross-Sectional Studies; D019468:Disease Management; D018450:Disease Progression; D004417:Dyspnea / Q000209:etiology; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010366:Peak Expiratory Flow Rate; D010465:Perception; D017410:Practice Guidelines as Topic; D012135:Respiratory Sounds; D012648:Self Care; D014300:Trinidad and Tobago
D018927:Anti-Asthmatic Agents
Uncontrolled asthma; asthma burden; patient perception; peak expiratory flow; revised guidelines