Publicação
Prevalence and determinants of uncontrolled asthma in Portugal : a national population-based study
| Resumo: | Background: Asthma is a chronic disease that affects people worldwide with potentially negative effect on quality of life and in healthcare systems. Asthma control represents a main goal for the management of asthma disease. Notwithstanding the provided recommendations, international studies revealed low levels of disease control. Moreover, modifiable and non-modifiable factors have been identified as related to poor asthma control level. Aim: In this study we assessed the level of asthma control by individual’s perspective, in Portugal, and the determinants associated with uncontrolled asthma. Methods: 557 active asthmatic patients were identified by random phone number in households and 400 individuals (327 adults and 73 children) completed a questionnaire during 2011 to 2012. Asthma control was assessed based on Global Initiative for Asthma (GINA) guidelines recommendations. In adults, besides the evaluation of GINA based symptom control, we additionally determined the self-perception of control and the level of control according to Asthma Control TestTM (ACT). Results: The fulfilment of the GINA criteria was accomplished only in 3.5% of the individuals. The presence of asthma symptoms in the previous four weeks was reported by 52.1%, and the occurrence of an acute episode in the past twelve months by 70% individuals. Life activity limitations caused by asthma disease was the main criteria reported as failure (78.8%). 93.9% of adults perceived asthma as being completely, well or somewhat controlled, which didn’t match the objective assessment of control. 35.2% had uncontrolled asthma, 64.8% partially controlled and none of the individuals had totally control of asthma assessed by ACT test. Factors significantly associated with poor asthma control scores were: age (OR 1.02 per year of age; 95% CI: 1.01-1.03), female sex (OR 1.87; 95% CI: 1.15-3.04), educational level (OR 0.5; 95% CI: 0.28-0.89 at high school level or more), occupation (OR 4.92; 95% CI: 2.12-11.42 if looking for a first job or being unemployed) (OR 2.51; 95% CI: 1.35-4.65 if being retired), income (OR 0.23; 95% CI: 0.07-0.72 if >619 euros), BMI (OR 1.09 per BMI unit; 95% CI: 1.03-1.14), having rhinitis symptoms (OR 4.40; 95% CI: 2.56-7.58) and using inhaled corticosteroids (OR 0.44; 95 %CI: 0.24-0.82 if used in the past or never used). Looking for a first job or being unemployed, BMI and having rhinitis symptoms were the determinants remaining significant after multivariate adjustments. Conclusions: This study reveals that the state of asthma management in Portugal is far from the long-term goals as stipulated by GINA guidelines. Also, there is an overestimation of asthma control through patient perception. Uncontrolled asthma was associated with several determinants (age, sex, educational level, occupation, income, BMI, having rhinitis symptoms and the use of inhaled corticosteroids as part of treatment plan), from which their identification can contribute to improve the strategies of care on these patients. |
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| Autores principais: | Camarinha, Catarina de Paraíso, 1989- |
| Assunto: | Asthma Control Uncontrolled Determinants Teses de mestrado - 2019 |
| Ano: | 2019 |
| País: | Portugal |
| Tipo de documento: | dissertação de mestrado |
| Tipo de acesso: | acesso aberto |
| Instituição associada: | Universidade de Lisboa |
| Idioma: | inglês |
| Origem: | Repositório da Universidade de Lisboa |
| Resumo: | Background: Asthma is a chronic disease that affects people worldwide with potentially negative effect on quality of life and in healthcare systems. Asthma control represents a main goal for the management of asthma disease. Notwithstanding the provided recommendations, international studies revealed low levels of disease control. Moreover, modifiable and non-modifiable factors have been identified as related to poor asthma control level. Aim: In this study we assessed the level of asthma control by individual’s perspective, in Portugal, and the determinants associated with uncontrolled asthma. Methods: 557 active asthmatic patients were identified by random phone number in households and 400 individuals (327 adults and 73 children) completed a questionnaire during 2011 to 2012. Asthma control was assessed based on Global Initiative for Asthma (GINA) guidelines recommendations. In adults, besides the evaluation of GINA based symptom control, we additionally determined the self-perception of control and the level of control according to Asthma Control TestTM (ACT). Results: The fulfilment of the GINA criteria was accomplished only in 3.5% of the individuals. The presence of asthma symptoms in the previous four weeks was reported by 52.1%, and the occurrence of an acute episode in the past twelve months by 70% individuals. Life activity limitations caused by asthma disease was the main criteria reported as failure (78.8%). 93.9% of adults perceived asthma as being completely, well or somewhat controlled, which didn’t match the objective assessment of control. 35.2% had uncontrolled asthma, 64.8% partially controlled and none of the individuals had totally control of asthma assessed by ACT test. Factors significantly associated with poor asthma control scores were: age (OR 1.02 per year of age; 95% CI: 1.01-1.03), female sex (OR 1.87; 95% CI: 1.15-3.04), educational level (OR 0.5; 95% CI: 0.28-0.89 at high school level or more), occupation (OR 4.92; 95% CI: 2.12-11.42 if looking for a first job or being unemployed) (OR 2.51; 95% CI: 1.35-4.65 if being retired), income (OR 0.23; 95% CI: 0.07-0.72 if >619 euros), BMI (OR 1.09 per BMI unit; 95% CI: 1.03-1.14), having rhinitis symptoms (OR 4.40; 95% CI: 2.56-7.58) and using inhaled corticosteroids (OR 0.44; 95 %CI: 0.24-0.82 if used in the past or never used). Looking for a first job or being unemployed, BMI and having rhinitis symptoms were the determinants remaining significant after multivariate adjustments. Conclusions: This study reveals that the state of asthma management in Portugal is far from the long-term goals as stipulated by GINA guidelines. Also, there is an overestimation of asthma control through patient perception. Uncontrolled asthma was associated with several determinants (age, sex, educational level, occupation, income, BMI, having rhinitis symptoms and the use of inhaled corticosteroids as part of treatment plan), from which their identification can contribute to improve the strategies of care on these patients. |
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