Tailoring interventions: identifying predictors of poor asthma control

Abstract

BackgroundDetermining the factors that will predict long-term asthma control is essential for improving health outcomes and decreasing the burden on the health care system. Patient-reported outcomes (PROs) on health behaviors can provide valuable information about future asthma control but have rarely been considered in previous analyses. ObjectiveTo develop statistical models for evaluating the predictors of long-term asthma control using PROs such as scores of the Asthma Control Test and the Asthma Self-Efficacy Scale. MethodsOf 1,437 individuals contacted, 566 (39%) at baseline and 486 (34%) at follow-up completed the questionnaires, including 4 PROs (Asthma Control Test, Asthma Self-Efficacy Scale, Mini-Asthma Quality of Life Questionnaire, and Beliefs about Medication Questionnaire). Long-term asthma control was evaluated by assessing overuse of rescue medication and emergency department visits. A multivariate logistic generalized estimating equation model was fitted to evaluate the possible effect of the studied factors on asthma control. ResultsThe complete case generalized estimating equation analysis included 286 participants who had complete PROs at the 2 evaluation times. After adjusting for socioeconomic status and smoking status, the Mini-Asthma Quality of Life Questionnaire was a significant predictor of asthma exacerbation. For each 1-point increase on the Mini-Asthma Quality of Life Questionnaire, there was a 0.25 decrease in the odds of a patient's asthma getting out of control. ConclusionThese findings suggest opportunities to decrease the burden on health care by tailoring interventions that combine PROs with other clinical and sociodemographic variables.