PURPOSE: Review the baseline characteristics of asthmatic patients enrolled in a randomized controlled trial comparing disease managment of asthma to standard care.
METHODS: This study is a single center,prospective, randomized controlled trial enrolling 902 asthmatic patients (ages 5-64 years)into an 18 month study that compares usual care to two forms of disease management. Demographic data,asthma symptom and severity,spirometry, medication use, and medical utilization were obtained at baseline, and every 6 months by trained research staff.
RESULTS: Adult(n=429) and pediatric patients (n=473)had high rates of obesity and tobacco use/exposure. Fifty-eight percent of adult had a BMI ≥ 30 Kg/m2 and 28% of children had a BMI ≥ 95th percentile.Tobacco use/ tobacco exposure was noted in 16%/31% of adults and 0.4%/23% of children. Asthma action plans were present in only 10% of adults and 32% of children. At baseline, 46% of adults and 31% of children had severe persistent asthma. While mean FVC and FEV1 were normal at baseline, 24% of adults and 20% of children had ≥ 12% increase in FEV1 after bronchodilators. Inhaled corticosteroids were used in only 68% of adults and 70% of children. Long-acting beta-agonists were used in 54% of adults and 32% of children. Leukotriene inhibitors were used in 34% of adults and 41% of children. Inhaled anticholinergics were chronically used in 10% of adults and 2% of children. For the year prior to enrollment, study patients had an average score of 24.2% on the Lara Asthma Symptom Score (range 5-40).
CONCLUSION: This large community-based study demonstrates that a significant percentage of asthmatic patients remain suboptimally treated and have no written medical direction for responding to increased symtoms. Many patients have persistent symptoms with 10-20% demonstrating a significant response to bronchodilators.
CLINICAL IMPLICATIONS: Continued education of patients and physicians are required to optimize quality of life and reduce medical utilization in our asthmatic population. Continued use and exposure to tobacco as well as the rise of obesity needs to be addressed in this patient population.
DISCLOSURE: Jay Peters, None.