[Show abstract][Hide abstract] ABSTRACT: Despite the National Asthma Education and Prevention Program (NAEPP) guidelines that specify the goals of asthma control and management strategies, the number of patients with uncontrolled asthma remains high, and factors associated with uncontrolled asthma are unknown.
The aim was to examine the relationship between asthma control and socio-demographic characteristics, health-care access and use, asthma education, and medication use among adults with active asthma residing in New England.
Data from the 2006-2007 Behavior Risk Factor Surveillance System Adult Asthma Call-Back Survey were analyzed using multinomial logistic regression. Asthma control was categorized as "well controlled," "not well controlled," or "very poorly controlled" according to the NAEPP guidelines.
Of the respondents (n = 3079), 30% met the criteria for well-controlled asthma, 46% for not well-controlled asthma, and 24% for very poorly controlled asthma. Being of Hispanic ethnicity (odds ratio [OR] = 4.0; 95% confidence interval [CI] = 1.2-13.7), unemployed or unable to work (OR = 17.9; 95% CI = 6.0-53.4), high school educated or less (OR = 2.8; 95% CI = 1.6-4.7), current smokers (OR = 2.5; 95% CI = 1.3-5.1), or being unable to see a doctor or specialist for asthma care or unable to buy medication for asthma because of cost (OR = 7.6; 95% CI = 3.4-17.1) were associated with very poorly controlled asthma. In addition, having Coronary Obstructive Pulmonary Disease (COPD) (OR = 2.6; 95% CI = 1.5-4.5), two or more routine checkups for asthma (OR = 4.5; 95% CI = 2.3-8.9), or an emergency department visit, urgent care facility visit, and hospitalization in the past year (OR = 3.9; 95% CI = 2.1-7.3) were also associated with having very poorly controlled asthma. Using controller medication in the past year (OR = 2.6; 95% CI = 1.6-4.2) and taking a course on how to manage asthma (OR = 3.0; 95% CI = 1.2-7.8) were significantly associated with poor asthma control.
The high prevalence (70%) of not well-controlled asthma and poorly controlled asthma in this study emphasizes the need to identify factors associated with poor asthma control for development of targeted intervention. A health policy of increasing asthma education, health-care access, and smoking cessation may be effective and result in better asthma control and management.
Full-text · Article · Jun 2011 · Journal of Asthma
[Show abstract][Hide abstract] ABSTRACT: The National Asthma Education Prevention Program's (NAEPP) Expert Panel Report 3 (EPR3) guidelines have stressed the need for environmental control measures for asthma, but there is limited evidence of their efficacy.
To examine the effectiveness of an in-home asthma intervention program for children and adults in Connecticut, we conducted a panel study to analyze quality-of-life indicators for asthmatic patients and the cost-benefit relationship in preventive care versus acute care.
The Asthma Indoor Reduction Strategies (AIRS) program was developed to reduce acute asthma episodes and improve asthma control through patient education and a home environmental assessment. Follow-up was conducted at 2-week, 3-month, and 6-month intervals. Measured quality-of-life indicators included number of unscheduled acute care visits, days absent from school/work due to asthma, times rescue inhaler used, and number of symptom-free days. Repeated measures analysis of variance (ANOVA) was used to determine whether significant differences exist in quality-of-life indicators at follow-up compared to that at the initial visit. Cost-benefit analysis was conducted by tabulating costs associated with physician office visits and emergency department (ED) visits due to asthma for children and adults separately.
Twenty percent of participants in the program met the criteria for well-controlled asthma, 16% for not well-controlled asthma, and 64% for very poorly controlled asthma. At 6 months follow-up, the mean number of unscheduled acute care visits, days absent from school/work due to asthma, and times rescue inhaler used in the past week decreased by 87%, 82%, and 74%, respectively, whereas the mean number of symptom-free days increased by 27% compared to the initial visit. Furthermore, the percent of participants with very poorly controlled asthma decreased from 64% at initial visit to 13% at 6 months follow-up. All changes were statistically significant at p < 0.05. A net savings of $26,720 per 100 participants was estimated at 6 months follow-up due to decreases in unscheduled acute care visits for adults and children.
Significant improvement in quality-of-life and decreases in healthcare resource utilization and costs were found after implementation of the AIRS program in Connecticut.
[Show abstract][Hide abstract] ABSTRACT: To identify environmental triggers associated with asthma severity and the potential modifying effect of cigarette smoke, the authors examined the relationship between sociodemographic characteristics, controller medication use, environmental triggers, and actions taken to reduce triggers on asthma severity among adults (≥18 years) residing in New England using the Behavior Risk Factor Surveillance Survey (BRFSS) Asthma Call-Back data. Asthma severity was categorized as intermittent, mild persistent, moderate persistent, and severe persistent according to the National Asthma Education and Prevention Program guidelines. In weighted logistic regression models, asthma severity was analyzed for 3075 adults with active asthma in Connecticut, Massachusetts, Maine, New Hampshire, and Vermont from 2006 to 2007. The odds of more severe asthma were 1.8 for smokers as compared with nonsmokers (95% confidence interval [CI] = 1.1, 3.1). Among current smokers, the odds of more severe asthma among those who were exposed to wood stoves was 2.4 (95% CI = 1.1, 5.7) as compared with those who were not exposed to wood stoves. Among nonsmokers, those who had a high school education or less (odds ratio [OR] = 2.0, 95% CI = 1.2, 3.3), had some college or technical school education (OR = 2.1, 95% CI = 1.2, 3.7), or had any comorbidity factors such as chronic obstructive pulmonary disease, emphysema, or bronchitis (OR = 2.5, 95% CI = 1.6, 3.8) were significantly associated with more severe asthma. Furthermore, the odds for more severe asthma were 2.1 (95% CI = 1.1, 4.0) among nonsmokers who were exposed to environmental tobacco smoke (ETS) as compared with those who were not exposed to ETS. The effect of environmental triggers on asthma severity differs among smokers and nonsmokers, even after controlling for sociodemographic factors, medication use, and actions taken to reduce triggers. Targeting smokers with asthma and making modifications to the environment may be important for reducing asthma severity among a high-risk population.
Preview · Article · Dec 2010 · Journal of Asthma and Allergy Educators