Uncontrolled Asthma Rates Increase at Higher GINA Treatment Steps

The rates of uncontrolled asthma, asthma exacerbations, and health care use correspondingly increased with each level increase in Global Initiative for Asthma (GINA) treatment steps, according to study results published in the Journal of Asthma.

A total of 714 participants from a population-based asthma cohort within the Obstructive Lung Disease in Northern Sweden (OLIN) studies were included in this follow-up analysis. Researchers conducted a structured interview asking participants about respiratory symptoms, smoking habits, exacerbations, pharmacologic asthma treatment, and health care use. In addition, the validated Asthma Control Test was used to assess asthma control. The self-administered, 8-item Short-Form Health Survey (SF-8) was used to examine generic physical and mental dimensions of health.

Treatment of asthma was classified according to GINA 2017 treatment steps. In steps 1 to 3, patients are treated with a short-acting beta₂ agonist or long-acting beta₂ agonist without inhaled corticosteroids (ICS), as-needed ICS, or maintenance (most days per week) low-dose ICS with or without long-acting beta₂ agonists. Treatment steps 4 to 5 were defined as maintenance with medium- to high-dose ICS and/or maintenance or as-needed oral corticosteroids.

The rate of uncontrolled asthma increased per treatment step, from no treatment to treatment steps 1 to 3 and to treatment steps 4 to 5 (9.9% vs 24.1% vs 39.9%, respectively; test for trend P <.001). Uncontrolled asthma was associated with a higher proportion of patients reporting exacerbations (23.5% for no treatment vs 31.8% for treatment steps 1-3 vs 52.1% for treatment steps 4-5; P =.013) in contrast to controlled asthma. Women were more likely than men to report exacerbations (25.2% vs 16.5%, respectively; P =.005).

Uncontrolled asthma was also associated with greater health care use (eg, any health care visits in the last 12 months, emergency department visits in the last 12 months, and hospitalizations in the last 12 months) and worse SF-8 status. A higher proportion of women reported ≥1 physician follow-up visit per year than men (21.2% vs 14.6%, respectively; P =.022). Although worse health status was associated with uncontrolled asthma, it was not associated with the level of GINA treatment.

A limitation of the study was the lack of a disease-specific asthma quality-of-life questionnaire, which may have provided additional insight into participants’ health status.

“Follow-up visits may be one of the most important improvements in asthma care,” the researchers added, “with the aim to give patients a personalized asthma management plan according to guidelines recommendations.”

Reference

Stridsman C, Axelsson M, Warm K, Backman H. Uncontrolled asthma occurs in all GINA treatment steps and is associated with worse physical health — a report from the OLIN adult asthma cohort [published online January 14, 2020]. J Asthma. doi:10.1080/02770903.2020.1713150