Identification of predictors associated with poor asthma control and asthma exacerbations
Published online: July 2021
Poor asthma control and severe asthma exacerbations have the most influence on the prognosis and quality of life of people with asthma. Although asthma exacerbations occur most frequently in patients with severe asthma, asthma exacerbations can also occur in patients with mild or moderate asthma when not optimally treated. Achieving optimal asthma control and minimizing the risk of exacerbation are the main goals of asthma treatment. Identifying predictors of asthma control and asthma exacerbations is likely to improve the management of patients at risk to experience those events.
In a recent article in The Journal of Allergy and Clinical Immunology: In Practice, Lemiere et al. reported the results of a study that aimed to assess the predictors of poor asthma control and asthma exacerbations within a population of moderate to severe asthmatic patients treated in a tertiary care center. They assessed 738 patients previously enrolled in a clinical registry. These patients had a diagnosis of asthma confirmed by a respirologist. Sociodemographic and clinical data were collected at enrolment in the registry, and patients were followed for a two-year period thereafter. The information regarding exacerbations that occurred during follow-up was collected in Quebec administrative databases.
Seven hundred and thirty-eight subjects (64% women) were assessed. Psychological distress, smoking, and poor lung function appeared as significant factors associated with uncontrolled asthma. Occurrence of previous asthma exacerbations, poor asthma control associated with overuse of beta-2 agonists, poor lung function, and older age were associated with asthma exacerbations. Whether overuse of beta2 agonists reflected poor asthma control or played an independent role in the occurrence of asthma exacerbation could not be determined in this study.
Predictors of asthma control differed from predictors of asthma exacerbations within the same population. Psychological distress and current smoking are modifiable factors that need to be addressed in tailored behavioural interventions to improve asthma control. Asthma exacerbations were mostly associated with the intrinsic severity of the disease
The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.