Abstract
BackgroundAsthma is a complex disease presenting with variable symptoms which are sometimes hard to control. The purpose of the study was to describe the prevalence of asthma symptoms, use of asthma medications and allergic sensitization in subjects with asthma. We also related those indices to the level of asthma control, lung function and in particular, cough.MethodsAn extensive questionnaire was sent to randomly selected adults from the West Sweden region. Clinical examinations and interview were performed in a subset. Of the participants, 744 were defined as having an ongoing asthma - reported ever having asthma or physician diagnosed asthma and one of the following – use of asthma medications, recurrent wheeze or attacks of shortness of breath with or without wheeze in the last 12 months. A respiratory disease-free control group of 847 subjects was also described.ResultsAccording to GINA guidelines, 40.6% of the asthmatics had partly controlled and 17.8% had uncontrolled asthma. Asthmatic subjects reported significantly more symptoms in the last 12 months than the control group – wheezing (79.4 vs 9.2%), shortness of breath (36.1 vs 2.5%), wheezing with shortness of breath (58.7 vs 1.3%). Important complaints were morning cough (42.5 vs 15.5%), cough with sputum production (36.1 vs 6.8%) and longstanding cough (32.5 vs 11.1%), which bothered two thirds of the uncontrolled and one third of partly controlled subjects. Asthma medications were used by 87.5% of the asthmatics, although around 30% of them who had insufficiently controlled disease used only short-acting beta-agonists. Asthmatics also had lower lung function, reacted to lower doses of methacholine that the controls and 13.6% of them had a FEV1/FVC ratio below 0.7. Allergic rhinitis was reported by 73.8% of the asthmatics and they were more frequently sensitized to several common allergens.ConclusionsApproximately 60% of asthmatics from this population-based study had insufficiently controlled asthma and persistent complaints, despite a high use of asthma medications. These self-reported symptoms were supported by clinical examination data. Increased cough frequency is an indicator of a more severe and difficult to control disease and should be considered when asthma is characterized.
Highlights
Asthma is a complex disease presenting with variable symptoms which are sometimes hard to control
Cough often presents as a longstanding symptom, even if the disease is adequately controlled by anti-inflammatory treatment, and recently it was shown that transient receptor potential vanilloid 1 channels are overexpressed in the bronchial epithelium of more severe asthma [10,11]
Asthma is often accompanied by several comorbidities like allergic rhinitis (AR) and chronic rhinosinusitis (CRS) which are considered to be substantial risk factors for asthma development [13,14,15,16] and the latter a predictor for more severe disease [17,18]
Summary
Asthma is a complex disease presenting with variable symptoms which are sometimes hard to control. The purpose of the study was to describe the prevalence of asthma symptoms, use of asthma medications and allergic sensitization in subjects with asthma We related those indices to the level of asthma control, lung function and in particular, cough. Cough often presents as a longstanding symptom, even if the disease is adequately controlled by anti-inflammatory treatment, and recently it was shown that transient receptor potential vanilloid 1 channels are overexpressed in the bronchial epithelium of more severe asthma [10,11]. Today’s mainstream asthma treatment is guided by the early use of anti-inflammatory medications and the increased need for reliever medications is considered an indicator of inadequately controlled disease [21]. Guidelines suggest the use of short-acting beta-2 agonists (SABA) alone should be given exclusively to a small group of asthmatics with intermittent disease
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