Sub-optimal asthma control: prevalence, detection and consequences in primary practice.
Eur Respir J. 2007 Oct 24;
Chapman KR, Boulet LP, Rea RM, Franssen E.
Toronto, Ontario, Canada.
Telephone surveys describing sub-optimal asthma control may be biased by low response rates. To obtain an unbiased assessment of asthma control and assess its impact in primary care Primary practitioners used a one page control questionnaire in 50 consecutive asthma patients.
Of 10,428 patients assessed by 354 physicians, 59% were uncontrolled, 19% well-controlled and 23% totally controlled. Physicians overestimated control, regarding only 42% of patients as uncontrolled. Physicians were more likely to report plans to alter the regimens of uncontrolled patients than controlled patients (1.29 versus 0.20 medication changes per patient, p<0.01) doing so in a fashion consistent with guideline recommendations. Of uncontrolled patients, 59% required one or more urgent care or specialist visits versus 26% of well-controlled and 15% of totally controlled patients. Patients were more likely to report short term symptom control when they had not required urgent or specialist care (OR 5.68; 95% CI 4.91-6.58).
The majority of asthma patients treated in primary practice are uncontrolled. Lack of control can be recognized by physicians who are likely to consider appropriate changes to therapy. A lack of short term symptom control of asthma is associated with excess health care utilization.