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Survey shows asthma not controlled in majority of patients

May 31, 2007

WINSTON-SALEM, N.C. - A survey of 1,812 patients with moderate-to-severe asthma revealed that the disease was not controlled in 55 percent, despite the fact that most had health insurance and visited their health care providers regularly.

"Even more shocking was the finding that 38 percent of controlled asthmatics and 54 percent of uncontrolled asthmatics reported having had an asthma attack during which they feared for their life," said Stephen P. Peters, M.D., Ph.D., lead author and a professor of pediatrics, internal medicine-pulmonary and associate director of the Center for Human Genomics at Wake Forest University School of Medicine.

The results from the survey, believed to be the first to assess the prevalence of uncontrolled asthma among a nationally representative sample of patients with moderate-to-severe asthma, are reported in the June issue of the Journal of Allergy and Clinical Immunology.

The Web-based survey was administered to patients with a diagnosis of asthma for at least one year who were prescribed standard therapy for preventing symptoms. Over the past 15 years, the National Asthma Education and Prevention Program has emphasized daily preventive management as opposed to treating asthma attacks.

The objective of the Real-World Evaluation of Asthma Control and Treatment (REACT) study was to assess the prevalence of uncontrolled asthma and the factors associated with the lack of control. Participants answered questions about demographics and health care use and completed a five-item test (Asthma Control Test, or ACT) to assess asthma control.

"We found that uncontrolled asthma is highly prevalent in patients using standard asthma medications," said Peters. "Our results highlight the critical need for improved asthma care and suggest that clinicians should expect a high rate of uncontrolled disease among their asthma patients."

Uncontrolled asthma has been associated with significant costs. In 2003, reports show that asthma caused about 24.5 million missed days of work, 12.7 million physician office visits and 1.2 million outpatient visits.

The REACT study found that the proportion of patients reporting two or more emergency department visits, hospitalization or three or more missed days of work/school because of asthma in the past year was more than three times greater in patients with uncontrolled asthma than in patients with controlled asthma.

There were several factors associated with uncontrolled asthma, including younger age, Hispanic race, male, and lower income. A significant number of participants with uncontrolled asthma also had gastroesophageal reflux (GERD), chronic sinusitis, or high blood pressure, which may contribute to the severity of their asthma.

Also likely contributing to poorly controlled asthma was the fact that only a minority of patients reported having received a personalized asthma action plan from their physician (26 percent of controlled asthmatics and 35 percent of uncontrolled asthmatics). Written asthma action plans have been associated with decreased emergency department visits, fewer hospitalizations and improved lung function.

The authors said several steps are needed to improve levels of asthma control, including providing patients with individual treatment plans, treating other medical problems such as GERD and using better tests to assess control, such as the ACT questionnaire used in the survey.

Wake Forest University Baptist Medical Center