Specialist asthma care results in superior assessment of asthma control

Abstract

Rationale Asthma management guidelines indicate that the goal of treatment is optimal control. The purpose of this study is to explore whether the achievement of asthma control among patients cared for by specialists differs from non-specialists. Methods The Asthma Control Test™ (ACT), a validated 5-item self-administered survey to assess asthma control, was administered in two separate studies to a total of 784 patients with asthma in practices of asthma specialists. In one study, 471 patients were under routine care of an asthma specialist and in another, 313 patients were not. The specialist's rating of asthma control (post-spirometry) was collected. Chi-square and t-tests were used to test differences between groups in specialist ratings of control, ACT scores and FEV 1. Results More patients with specialist care compared with those without such care demonstrated better control as measured by physician and patient ratings of control, ACT scores (p<0.00001 for all) and individual ACT items (p<0.02). A lower proportion of patients under the care of asthma specialists required stepped-up therapy compared with patients not under care of asthma specialists (26% vs 49%, p<0.00001). Patients receiving specialist care exhibited better control despite having lower average FEV 1 values (84% vs 89%; p<0.0022). Conclusions More patients under the care of asthma specialists reported control and had higher ACT scores. This suggests that better asthma control was achieved through specialist care even though specialist patients had more severe asthma. It also suggests that FEV 1 alone does not provide a complete assessment of control indicating that asthma control is not synonymous with severity.