Frequency and Risk Factors of Difficult-to-Control Asthma among Patients

Abstract

Abstract Background Difficult-to-control asthma (DTA) is associated with significant medical and financial burden. Difficult-to-treat asthma is asthma that is uncontrolled despite Global Initiative for Asthma (GINA) Step 4 or 5 treatment (e.g. medium or high dose inhaled corticosteroids (ICS) with a second controller; maintenance OCS), or that requires such treatment to maintain good symptom control and reduce the risk of exacerbations Objectives to assess causes and possible precipitating factors for difficult-tocontrol asthma in Kafr Elsheikh Chest Hospital. Patients and Methods This prospective cohort study enrolled 40 adult with DTA who were followed for 12 weeks. At the start, patients who had scores suggestive of DTA by using asthma control test (ACT) and questionnaire(ACQ) were enrolled. Spirometry was done at the start and adherence was ensured then spirometry was done again to eliminate possibility of non-adherence as a cause of uncontrolled asthma. ACQ and ACT were reassessed to classify patients. Result Male: female ratio was 1:1. Age ranged from 18.0 to 74.0 years. After twelve weeks, difficult-to-control asthma still present in 27.5%. There is statistically significant relation between DTA and all of family history of asthma, gastroesophageal reflux (GERD), allergic rhinitis/sinusitis, duration of asthma. On multivariate analysis, GERD, positive family history, comorbid allergic rhinitis, associated allergies and disease duration≥10 years increase risk of DTA by 4.56, 12.94, 1.389, 13.74 and 14.733 folds respectively. Conclusion GERD, positive family history, presence of allergic rhinitis, associated allergies and disease duration≥10 years were independent risk factors for DTA.