PURPOSE: Few asthmatic patients currently achieve control. Factors contributing to poor asthma control are low use of controller therapy, misuses of management guidelines and misestimating of asthma control by both patients and physicians. In low socioeconomic population comprehensive management efforts to reduce asthma morbidity have not been conclusive. The aim of our study is to identify contributing factors of uncontrolled asthma in this population independent of their low income.
METHODS: A low socioeconomic population seeking medical care in a nongovernmental organization (Hariri foundation) was studied. The foundation offers access to medical care ressources including physicians, laboratory exams and treatment at almost free prices. Asthma control test (ACT) was administered to 110 asthmatic patients scored on a scale from 5 (not controlled at all) to 25 (completely controlled). Asthmatics scored less than 20 are considered uncontrolled. Demographics data, starting age, seasonal and perennial disease, asthma severity, treatment and exposure to smoking were analyzed.
RESULTS: 62 patients (56.4%) have uncontrolled asthma and only 8 patients (7.3%) have complete control. Seasonal asthma was diagnosed in 75% of patients. Active and passive smokers are 19.1% and 29.1% respectively. Inhaled steroids, leukotrienes modifiers, long acting bronchodilators and short acting bronchodilators are used in 23.6%, 13.6%, 17.3% and 72.7% respectively. Patients asthma severity are distributed as GINA I (33.6%), GINA II (20.9%), GINA III (28.2%) and GINA IV (17.3%) are statistically correlated with the ACT score 23±1.7, 18±2.2, 14.8±3.6, 10.7±3.4 respectively (p < 10–3). Independent of GINA staging, multiple analysis using linear regression determined ACT score significant related to passive smoking (beta −3.23 SE 1.50 (p 0.036)) and perennial compared to seasonal asthma (beta −2.76 SE 1.47 (p 0.06)).
CONCLUSION: Control asthma necessitates supplementary management efforts to adapt treatment plan for the severity of the disease, to extend treatment period and to eliminate passive smoking.
CLINICAL IMPLICATIONS: Even with all medical resources and economic facilities, asthma control is still unsatisfactory in a low socioeconomic population.
DISCLOSURE: Moussa Riachy, None.