Allergy Asthma Immunol Res.  2011 Oct;3(4):217-225. 10.4168/aair.2011.3.4.217.

Current Control and Future Risk in Asthma Management

• Sims EJ
• Price D
• Haughney J
• Ryan D
• Thomas M

• KMID: 2167072
• DOI: http://doi.org/10.4168/aair.2011.3.4.217

Abstract

Despite international and national guidelines, poor asthma control remains an issue. Asthma exacerbations are costly to both the individual, and the healthcare provider. Improvements in our understanding of the therapeutic benefit of asthma therapies suggest that, in general, while long-acting bronchodilator therapy improves asthma symptoms, the anti-inflammatory activity of inhaled corticosteroids reduces acute asthma exacerbations. Studies have explored factors which could be predictive of exacerbations. A history of previous exacerbations, poor asthma control, poor inhaler technique, a history of lower respiratory tract infections, poor adherence to medication, the presence of allergic rhinitis, gastro-oesophageal reflux disease, psychological dysfunction, smoking and obesity have all been implicated as having a predictive role in the future risk of asthma exacerbation. Here we review the current literature and discuss this in the context of primary care management of asthma.

Keyword

Asthma; control; disease exacerbation; primary health care

MeSH Terms

Adrenal Cortex Hormones
Asthma
Disease Progression
Gastroesophageal Reflux
Health Personnel
Humans
Nebulizers and Vaporizers
Obesity
Primary Health Care
Respiratory Tract Infections
Rhinitis
Rhinitis, Allergic, Perennial
Smoke
Smoking
Adrenal Cortex Hormones
Smoke

Reference

1. Reddel HK, Taylor DR, Bateman ED, Boulet LP, Boushey HA, Busse WW, Casale TB, Chanez P, Enright PL, Gibson PG, de Jongste JC, Kerstjens HA, Lazarus SC, Levy ML, O'Byrne PM, Partridge MR, Pavord ID, Sears MR, Sterk PJ, Stoloff SW, Sullivan SD, Szefler SJ, Thomas MD, Wenzel SE. An official American Thoracic Society/European Respiratory Society statement: asthma control and exacerbations: standardizing endpoints for clinical asthma trials and clinical practice. Am J Respir Crit Care Med. 2009. 180:59–99.

2. Global Initiative for Asthma (GINA). Global Strategy for Asthma Management and Prevention 2009 (update). 2010.

3. Guilbert TW, Garris C, Jhingran P, Bonafede M, Tomaszewski KJ, Bonus T, Hahn RM, Schatz M. Asthma that is not well-controlled is associated with increased healthcare utilization and decreased quality of life. J Asthma. 2011. 48:126–132.

4. Bateman ED, Bousquet J, Busse WW, Clark TJ, Gul N, Gibbs M, Pedersen S. Stability of asthma control with regular treatment: an analysis of the Gaining Optimal Asthma controL (GOAL) study. Allergy. 2008. 63:932–938.

5. Bateman ED, Reddel HK, Eriksson G, Peterson S, Ostlund O, Sears MR, Jenkins C, Humbert M, Buhl R, Harrison TW, Quirce S, O'Byrne PM. Overall asthma control: the relationship between current control and future risk. J Allergy Clin Immunol. 2010. 125:600–608.e6.

6. Demoly P, Gueron B, Annunziata K, Adamek L, Walters RD. Update on asthma control in five European countries: results of a 2008 survey. Eur Respir Rev. 2010. 19:150–157.

7. Price D, Horne R, Ryan D, Freeman D, Lee A. Large variations in asthma control between UK general practices participating in the asthma control, concordance and tolerance (ACCT) initiative [abstract]. Prim Care Respir J. 2006. 15:206.

8. Breekveldt-Postma NS, Erkens JA, Aalbers R, van de Ven MJ, Lammers JW, Herings RM. Extent of uncontrolled disease and associated medical costs in severe asthma--a PHARMO study. Curr Med Res Opin. 2008. 24:975–983.

9. British Thoracic Society. Scottish Intercollegiate Guidelines Network. British Guideline on the Management of Asthma. A national clinical guideline. 2009.

10. Taylor DR, Bateman ED, Boulet LP, Boushey HA, Busse WW, Casale TB, Chanez P, Enright PL, Gibson PG, de Jongste JC, Kerstjens HA, Lazarus SC, Levy ML, O'Byrne PM, Partridge MR, Pavord ID, Sears MR, Sterk PJ, Stoloff SW, Szefler SJ, Sullivan SD, Thomas MD, Wenzel SE, Reddel HK. A new perspective on concepts of asthma severity and control. Eur Respir J. 2008. 32:545–554.

11. Bateman ED, Hurd SS, Barnes PJ, Bousquet J, Drazen JM, FitzGerald M, Gibson P, Ohta K, O'Byrne P, Pedersen SE, Pizzichini E, Sullivan SD, Wenzel SE, Zar HJ. Global strategy for asthma management and prevention: GINA executive summary. Eur Respir J. 2008. 31:143–178.

12. Thomas M, Leather D, Price D. High-dose inhaled corticosteroids and add-on therapy use in adults with asthma in the UK in 2003: an observational study. Prim Care Respir J. 2006. 15:166–172.

13. Peters D, Chen C, Markson LE, Allen-Ramey FC, Vollmer WM. Using an asthma control questionnaire and administrative data to predict health-care utilization. Chest. 2006. 129:918–924.

14. Price D, Zhang Q, Kocevar VS, Yin DD, Thomas M. Effect of a concomitant diagnosis of allergic rhinitis on asthma-related health care use by adults. Clin Exp Allergy. 2005. 35:282–287.

15. Stephenson JJ, Quimbo RA, Gutierrez B. Subacute lack of asthma control as a predictor of subsequent acute asthma exacerbation in a managed care population. Am J Manag Care. 2010. 16:108–114.

16. O'Connor RD, Bleecker ER, Long A, Tashkin D, Peters S, Klingman D, Gutierrez B. Subacute lack of asthma control and acute asthma exacerbation history as predictors of subsequent acute asthma exacerbations: evidence from managed care data. J Asthma. 2010. 47:422–428.

17. Dolan CM, Fraher KE, Bleecker ER, Borish L, Chipps B, Hayden ML, Weiss S, Zheng B, Johnson C, Wenzel S. Design and baseline characteristics of the epidemiology and natural history of asthma: Outcomes and Treatment Regimens (TENOR) study: a large cohort of patients with severe or difficult-to-treat asthma. Ann Allergy Asthma Immunol. 2004. 92:32–39.

18. Miller MK, Lee JH, Miller DP, Wenzel SE. Recent asthma exacerbations: a key predictor of future exacerbations. Respir Med. 2007. 101:481–489.

19. Campbell JD, Blough DK, Sullivan SD. Comparison of guideline-based control definitions and associations with outcomes in severe or difficult-to-treat asthma. Ann Allergy Asthma Immunol. 2008. 101:474–481.

20. Nathan RA, Sorkness CA, Kosinski M, Schatz M, Li JT, Marcus P, Murray JJ, Pendergraft TB. Development of the asthma control test: a survey for assessing asthma control. J Allergy Clin Immunol. 2004. 113:59–65.

21. Juniper EF, Svensson K, Mörk AC, Ståhl E. Measurement properties and interpretation of three shortened versions of the asthma control questionnaire. Respir Med. 2005. 99:553–558.

22. Sullivan SD, Wenzel SE, Bresnahan BW, Zheng B, Lee JH, Pritchard M, Kamath TV, Weiss ST. Association of control and risk of severe asthma-related events in severe or difficult-to-treat asthma patients. Allergy. 2007. 62:655–660.

23. National Asthma Education and Prevention Program. Expert Panel Report 3 (EPR-3): Guidelines for the Diagnosis and Management of Asthma-Summary Report 2007. J Allergy Clin Immunol. 2007. 120:S94–S138.

24. National Heart Lung, and Blood Institute. National Asthma Education and Prevention Program. Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma. 2007. National Institutes of Health/National Heart, Lung, and Blood Institute.

25. Haselkorn T, Fish JE, Zeiger RS, Szefler SJ, Miller DP, Chipps BE, Simons FE, Weiss ST, Wenzel SE, Borish L, Bleecker ER. Consistently very poorly controlled asthma, as defined by the impairment domain of the Expert Panel Report 3 guidelines, increases risk for future severe asthma exacerbations in The Epidemiology and Natural History of Asthma: Outcomes and Treatment Regimens (TENOR) study. J Allergy Clin Immunol. 2009. 124:895–902.e1-4.

26. Papi A, Haughney J, Virchow JC, Roche N, Palkonen S, Price D. Inhaler devices for asthma: a call for action in a neglected field. Eur Respir J. 2011. 37:982–985.

27. Melani AS, Bonavia M, Cilenti V, Cinti C, Lodi M, Martucci P, Serra M, Scichilone N, Sestini P, Aliani M, Neri M. Inhaler mishandling remains common in real life and is associated with reduced disease control. Respir Med. 2011. 105:930–938.

28. Rollins DR, Beuther DA, Martin RJ. Update on infection and antibiotics in asthma. Curr Allergy Asthma Rep. 2010. 10:67–73.

29. Price D, Martin RJ, Barnes N, Dorinsky P, Israel E, Roche N, Chisholm A, Hillyer EV, Kemp L, Lee AJ, von Ziegenweidt J, Colice G. Prescribing practices and asthma control with hydrofluoroalkane-beclomethasone and fluticasone: a real-world observational study. J Allergy Clin Immunol. 2010. 126:511–518.e1-10.

30. Suissa S, Ernst P, Kezouh A. Regular use of inhaled corticosteroids and the long term prevention of hospitalisation for asthma. Thorax. 2002. 57:880–884.

31. Clatworthy J, Price D, Ryan D, Haughney J, Horne R. The value of self-report assessment of adherence, rhinitis and smoking in relation to asthma control. Prim Care Respir J. 2009. 18:300–305.

32. Bousquet J, Van Cauwenberge P, Khaltaev N. Allergic rhinitis and its impact on asthma. J Allergy Clin Immunol. 2001. 108:S147–S334.

33. Bousquet J. Allergic Rhinitis and its Impact on Asthma (ARIA). Clin Exp All Rev. 2003. 3:43–45.

34. Bousquet J, Khaltaev N, Cruz AA, Denburg J, Fokkens WJ, Togias A, Zuberbier T, Baena-Cagnani CE, Canonica GW, van Weel C, Agache I, Aït-Khaled N, Bachert C, Blaiss MS, Bonini S, Boulet LP, Bousquet PJ, Camargos P, Carlsen KH, Chen Y, Custovic A, Dahl R, Demoly P, Douagui H, Durham SR, van Wijk RG, Kalayci O, Kaliner MA, Kim YY, Kowalski ML, Kuna P, Le LT, Lemiere C, Li J, Lockey RF, Mavale-Manuel S, Meltzer EO, Mohammad Y, Mullol J, Naclerio R, O'Hehir RE, Ohta K, Ouedraogo S, Palkonen S, Papadopoulos N, Passalacqua G, Pawankar R, Popov TA, Rabe KF, Rosado-Pinto J, Scadding GK, Simons FE, Toskala E, Valovirta E, van Cauwenberge P, Wang DY, Wickman M, Yawn BP, Yorgancioglu A, Yusuf OM, Zar H, Annesi-Maesano I, Bateman ED, Ben Kheder A, Boakye DA, Bouchard J, Burney P, Busse WW, Chan-Yeung M, Chavannes NH, Chuchalin A, Dolen WK, Emuzyte R, Grouse L, Humbert M, Jackson C, Johnston SL, Keith PK, Kemp JP, Klossek JM, Larenas-Linnemann D, Lipworth B, Malo JL, Marshall GD, Naspitz C, Nekam K, Niggemann B, Nizankowska-Mogilnicka E, Okamoto Y, Orru MP, Potter P, Price D, Stoloff SW, Vandenplas O, Viegi G, Williams D. Allergic Rhinitis and its Impact on Asthma (ARIA) 2008 update (in collaboration with the World Health Organization, GA(2)LEN and AllerGen). Allergy. 2008. 63:Suppl 86. 8–160.

35. Thomas M, Kocevar VS, Zhang Q, Yin DD, Price D. Asthma-related health care resource use among asthmatic children with and without concomitant allergic rhinitis. Pediatrics. 2005. 115:129–134.

36. Price D, Kemp L, Sims E, von Ziegenweidt J, Navaratnam P, Lee AJ, Chisholm A, Hillyer EV, Gopalan G. Observational study comparing intranasal mometasone furoate with oral antihistamines for rhinitis and asthma. Prim Care Respir J. 2010. 19:266–273.

37. Haselkorn T, Zeiger RS, Chipps BE, Mink DR, Szefler SJ, Simons FE, Massanari M, Fish JE. Recent asthma exacerbations predict future exacerbations in children with severe or difficult-to-treat asthma. J Allergy Clin Immunol. 2009. 124:921–927.

38. Havemann BD, Henderson CA, El-Serag HB. The association between gastro-oesophageal reflux disease and asthma: a systematic review. Gut. 2007. 56:1654–1664.

39. Chen H, Gould MK, Blanc PD, Miller DP, Kamath TV, Lee JH, Sullivan SD. Asthma control, severity, and quality of life: quantifying the effect of uncontrolled disease. J Allergy Clin Immunol. 2007. 120:396–402.

40. Thomas M, Price D. Impact of comorbidities on asthma. Expert Rev Clin Immunol. 2008. 4:731–742.

41. Hibbert G, Pilsbury D. Demonstration and treatment of hyperventilation causing asthma. Br J Psychiatry. 1988. 153:687–689.

42. Rimington LD, Davies DH, Lowe D, Pearson MG. Relationship between anxiety, depression, and morbidity in adult asthma patients. Thorax. 2001. 56:266–271.

43. Lavoie KL, Cartier A, Labrecque M, Bacon SL, Lemière C, Malo JL, Lacoste G, Barone S, Verrier P, Ditto B. Are psychiatric disorders associated with worse asthma control and quality of life in asthma patients? Respir Med. 2005. 99:1249–1257.

44. McLeish AC, Zvolensky MJ, Luberto CM. The role of anxiety sensitivity in terms of asthma control: a pilot test among young adult asthmatics. J Health Psychol. 2011. 16:439–444.

45. Kullowatz A, Kanniess F, Dahme B, Magnussen H, Ritz T. Association of depression and anxiety with health care use and quality of life in asthma patients. Respir Med. 2007. 101:638–644.

46. Robinson DS, Campbell DA, Durham SR, Pfeffer J, Barnes PJ, Chung KF. Systematic assessment of difficult-to-treat asthma. Eur Respir J. 2003. 22:478–483.

47. Wainwright NW, Surtees PG, Wareham NJ, Harrison BD. Psychosocial factors and incident asthma hospital admissions in the EPIC-Norfolk cohort study. Allergy. 2007. 62:554–560.

48. Barton CA, McKenzie DP, Walters EH, Abramson MJ. Interactions between psychosocial problems and management of asthma: who is at risk of dying? J Asthma. 2005. 42:249–256.

49. ten Brinke A, Ouwerkerk ME, Zwinderman AH, Spinhoven P, Bel EH. Psychopathology in patients with severe asthma is associated with increased health care utilization. Am J Respir Crit Care Med. 2001. 163:1093–1096.

50. ten Brinke A, Ouwerkerk ME, Bel EH, Spinhoven P. Similar psychological characteristics in mild and severe asthma. J Psychosom Res. 2001. 50:7–10.

51. Pedersen SE, Bateman ED, Bousquet J, Busse WW, Yoxall S, Clark TJ. Determinants of response to fluticasone propionate and salmeterol/fluticasone propionate combination in the Gaining Optimal Asthma controL study. J Allergy Clin Immunol. 2007. 120:1036–1042.

52. Schatz M, Zeiger RS, Vollmer WM, Mosen D, Cook EF. Determinants of future long-term asthma control. J Allergy Clin Immunol. 2006. 118:1048–1053.

53. Ford ES. The epidemiology of obesity and asthma. J Allergy Clin Immunol. 2005. 115:897–909.

54. Chinn S. Obesity and asthma: evidence for and against a causal relation. J Asthma. 2003. 40:1–16.

55. Burgess JA, Walters EH, Byrnes GB, Giles GG, Jenkins MA, Abramson MJ, Hopper JL, Dharmage SC. Childhood adiposity predicts adult-onset current asthma in females: a 25-yr prospective study. Eur Respir J. 2007. 29:668–675.

56. Barros LL, Souza-Machado A, Corrêa LB, Santos JS, Cruz C, Leite M, Castro L, Coelho AC, Almeida P, Cruz AA. Obesity and poor asthma control in patients with severe asthma. J Asthma. 2011. 48:171–176.

57. Haselkorn T, Fish JE, Chipps BE, Miller DP, Chen H, Weiss ST. Effect of weight change on asthma-related health outcomes in patients with severe or difficult-to-treat asthma. Respir Med. 2009. 103:274–283.

58. Lavoie KL, Bacon SL, Labrecque M, Cartier A, Ditto B. Higher BMI is associated with worse asthma control and quality of life but not asthma severity. Respir Med. 2006. 100:648–657.

59. Lai CK, Ko FW, Bhome A, de Guia TS, Wong GW, Zainudin BM, Nang AN, Boonsawat W, Cho SH, Gunasekera KD, Hong JG, Hsu JY, Viet NN, Yunus F, Mukhopadhyay A. Relationship between asthma control status, the Asthma Control TestTM and urgent health-care utilization in Asia. Respirology. 2011. 16:688–697.

60. Schatz M, Camargo CA Jr. The relationship of sex to asthma prevalence, health care utilization, and medications in a large managed care organization. Ann Allergy Asthma Immunol. 2003. 91:553–558.

61. Suissa S, Ernst P, Benayoun S, Baltzan M, Cai B. Low-dose inhaled corticosteroids and the prevention of death from asthma. N Engl J Med. 2000. 343:332–336.