Effective Asthma Management Strategies Linked to Better Long-term Asthma Control

November 13, 2006 — Effective asthma management strategies, especially regular use of inhaled corticosteroids, long-acting beta-agonists, and asthma specialist care, were independently associated with better long-term asthma control, according to the results of a study reported in the November issue of the Journal of Allergy & Clinical Immunology.

"Asthma control has been hypothesized to be inversely related to asthma severity, directly related to effective management, and also related to other definable factors, but empiric data to support this construct are few," write Michael Schatz, MD, MS, from the Kaiser-Permanente Medical Care Program in San Diego, California, and colleagues. "We sought to identify independent prospective determinants of future long-term asthma control among asthma severity, management, demographic, and comorbidity predictors."

In this study, a random sample of 2250 health maintenance organization members aged 18 to 56 years with persistent asthma completed surveys, and linked computerized pharmacy data provided information on medication dispensing at baseline and during the follow-up year. The main endpoint was long-term asthma control during the follow-up year based on a previously validated 4-level scale measuring the number of short-acting beta-agonist canister dispensings.

Logistic regression analyses showed that factors independently associated with poorer control were oral corticosteroid use (odds ratio [OR], 1.9) or unscheduled visits (OR, 1.2) in the prior year, any prior asthma hospitalizations (OR, 1.4), smoking (OR, 2.2), chronic obstructive pulmonary disease (OR, 1.9), male sex (OR, 1.5), black race (OR, 1.4), and lower educational level (OR, 1.1). Factors that were associated independently with better control were use of regular inhaled corticosteroids (OR, 0.7), long-acting beta-agonists (OR, 0.7), and asthma specialist care (OR, 0.6).

"Markers of asthma severity and other patient characteristics are inversely related to future asthma control, but effective management strategies are associated with improved asthma control, even after accounting for these high-risk characteristics," the authors write.

Study limitations include lack of generalizability to patients with intermittent asthma; sample primarily white, well-educated, nonpoor patients enrolled in a large health maintenance organization; 60% response rate; reliance on self-report; only modest discrimination provided by the final model; and the lack of objective measures, such as spirometry, to confirm the diagnosis of asthma and to determine pulmonary physiologic outcomes.

"Effective management strategies, especially regular use of inhaled corticosteroids, long-acting beta-agonists, and asthma specialist care, are independently associated with better long-term control, even after adjusting for other severity-related utilization, comorbidity, or demographic predictors," the authors conclude. "It is hoped that these data will be used to improve long-term asthma control among the many asthmatic patients in our world today."

The Kaiser-Permanente Care Management Institute in Oakland, California, supported this study. The authors have disclosed no relevant financial relationships.

J Allergy Clin Immunol. 2006;118:1048-1053.

Source: http://www.medscape.com/viewarticle/547688?src=0_nl_cme_9