Abstract

This cross-sectional study of the general population of Telemark County, Norway, aimed to identify risk factors associated with poor asthma control as defined by the Asthma Control Test (ACT), and to determine the proportions of patients with poorly controlled asthma who had undergone spirometry, used asthma medication, or been examined by a pulmonary physician. In 2014-2015, the study recruited 326 subjects aged 16-50 years who had self-reported physician-diagnosed asthma and presence of respiratory symptoms during the previous 12 months. The clinical outcome measures were body mass index (BMI), forced vital capacity (FVC) and forced expiratory volume in one second (FEV1), fractional exhaled nitric oxide (FeNO), immunoglobulin E (IgE) in serum and serum C-reactive protein (CRP). An ACT score ≤ 19 was defined as poorly controlled asthma. Overall, 113 subjects (35%) reported poor asthma control. The odds ratios (ORs) and 95% confidence intervals (CIs) for factors associated with poorly controlled asthma were: self-reported occupational exposure to vapor, gas, dust, or fumes during the previous 12 months (OR 2.0; 95% CI 1.1-3.6), body mass index ≥ 30 kg/m2 (OR 2.2; 95% CI 1.2-4.1), female sex (OR 2.6; 95% CI 1.5-4.7), current smoking (OR 2.8; 95% CI 1.5-5.3), and past smoking (OR 2.3; 95% CI 1.3-4.0). Poor asthma control was also associated with reduced FEV1 after bronchodilation (β -3.6; 95% CI -7.0 to -0.2). Moreover, 13% of the participants with poor asthma control reported no use of asthma medication, 51% had not been assessed by a pulmonary physician, and 20% had never undergone spirometry. Because these data are cross-sectional, further studies assessing possible risk factors in general and objectively measured occupational exposure in particular are needed. However, our results suggest that there is room for improvement with regards to use of spirometry and pulmonary physician referrals when a patient's asthma is inadequately controlled.

Highlights

  • Asthma is the most prevalent chronic respiratory disease globally and imposes a substantial burden on patients, families, and communities [1, 2]

  • While these studies stressed the association between treatment-related issues and poor asthma control, little attention has been given to other important risk factors including occupational exposure to allergens and irritants [2, 4]

  • Self-reported exposure to VGDF was associated with poor asthma control, as was obesity (BMI 30 kg/m2)

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Summary

Introduction

Asthma is the most prevalent chronic respiratory disease globally and imposes a substantial burden on patients, families, and communities [1, 2]. Asthma control has been evaluated in a number of international studies, including several regions of Europe, in which both physicians and patients have reported poor levels of symptom control [5, 6] These studies show that the prevalence of poor or suboptimal asthma control ranges from 57% to greater than 80%. The Recognise Asthma and Link to Symptoms and Experience (REALISE) survey found that levels of asthma control were poor in a real-life sample from the general population of 11 European countries: 45% of respondents had uncontrolled asthma, and the level of well-controlled asthma ranged from 15% in Germany to 28% in Austria [6] While these studies stressed the association between treatment-related issues and poor asthma control, little attention has been given to other important risk factors including occupational exposure to allergens and irritants [2, 4]. This information is considered to be important for improving work participation and asthmarelated quality of life

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