Camarinha C, Fernandes M, Alarc Úo V, Franco J, Mana ºas M E, B Írbara C, Nicola P J
Epidemiology Unit, Institute of Preventive Medicine and Public Health, Faculty of Medicine, University of Lisbon, Hospital de Santa Maria Avenida Professor Egas Moniz, 1649-035 Lisboa, Portugal; Allergy Center, CUF Descobertas Hospital, Rua M.írio Botas, 1998-018 Lisboa, Portugal.
CTI Clinical Trial and Consulting Services, Rua Tierno Galvan, Torre 3, Piso 16, 1070-274 Lisboa, Portugal.
Pulmonology. 2023 Jan-Feb;29(1):29-41. doi: 10.1016/j.pulmoe.2020.02.014. Epub 2020 Oct 3.
Asthma is a chronic and heterogeneous disease that affects people of all ages and has a high estimated increase in prevalence worldwide. Asthma control represents a main goal in the disease management. International studies revealed low levels of disease control resulting in a significant burden for healthcare systems, not only in terms of quality of life, but also in terms of health costs. Modifiable and non-modifiable factors have been identified as relating to poor asthma control level. In this study we evaluated the distribution of asthma control levels in Portuguese adult population and examine the determinants associated with uncontrolled asthma.
Using a similar methodology to the one employed in the Asthma Insights and Reality in Europe (AIRE) survey, 327 active asthmatic patients were identified by random phone number and completed a questionnaire during 2011 to 2012. Asthma control was assessed by the evaluation of GINA based symptom control, by Asthma Control Test.äó (ACT) and by self-perception of control. To examine the relationship between uncontrolled asthma and its determinants, univariate logistic regression analysis, sequential multivariable regression and population attributable risk percentage were determinate.
35.2% active asthmatic patients had uncontrolled asthma, 64.8% partially controlled and none of the individuals had total control of asthma assessed by ACT test. Factors significantly associated with poor asthma control scores were: age (OR 1.02 per year of age; 95% CI: 1.01.Çô1.03), female sex (OR 1.87; 95% CI: 1.15.Çô3.04), educational level (OR 0.5; 95% CI: 0.28.Çô0.89 at high school level or over), occupation (OR 4.92; 95% CI: 2.12.Çô11.42 if looking for a first job or unemployed) (OR 2.51; 95% CI: 1.35.Çô4.65 if being retired), income (OR 0.23; 95% CI: 0.07.Çô0.72 if >619 euros), BMI (OR 1.09 per BMI unit; 95% CI: 1.03.Çô1.14), having rhinitis symptoms (OR 4.40; 95% CI: 2.56.Çô7.58) and using inhaled corticosteroids (OR 0.44; 95%CI: 0.24.Çô0.82 if used in the past or never used). Looking for a first job or being unemployed, BMI and having rhinitis symptoms remained significant after multivariate adjustments.
Uncontrolled asthma was associated with several determinants. Their identification can contribute to improve asthma care both from clinical and from public health perspectives.
哮喘是一种慢性异质性疾病，影响各年龄段人群，且据估计全球患病率呈显著上升趋势。哮喘控制是疾病管理的主要目标。国际研究表明，疾病控制水平较低，这不仅给医疗保健系统带来了生活质量方面的沉重负担，也带来了健康成本方面的负担。已确定可改变和不可改变的因素与哮喘控制水平不佳有关。在本研究中，我们评估了葡萄牙成年人群中哮喘控制水平的分布情况，并研究了与未控制哮喘相关的决定因素。
采用与欧洲哮喘洞察与现实（AIRE）调查中使用的类似方法，通过随机电话号码识别出327名活动性哮喘患者，并在2011年至2012年期间完成了一份问卷。通过基于全球哮喘防治创议（GINA）的症状控制评估、哮喘控制测试（ACT）以及自我控制感知来评估哮喘控制情况。为研究未控制哮喘与其决定因素之间的关系，确定了单因素逻辑回归分析、序贯多变量回归以及人群归因风险百分比。
35.2%的活动性哮喘患者哮喘未得到控制，64.8%为部分控制，通过ACT测试评估，没有个体实现哮喘的完全控制。与哮喘控制评分不佳显著相关的因素有：年龄（每年年龄的比值比为1.02；95%置信区间：1.01至1.03）、女性（比值比为1.87；95%置信区间：1.15至3.04）、教育水平（高中及以上水平的比值比为0.5；95%置信区间：0.28至0.89）、职业（正在寻找第一份工作或失业者的比值比为4.92；95%置信区间：2.12至11.42）（退休者的比值比为2.51；95%置信区间：1.35至4.65）、收入（收入>619欧元时的比值比为0.23；95%置信区间：0.07至0.72）、体重指数（BMI）（每单位BMI的比值比为1.09；95%置信区间：1.03至1.14）、有鼻炎症状（比值比为4.40；95%置信区间：2.56至7.58）以及使用吸入性糖皮质激素（过去使用过或从未使用过的比值比为0.44；95%置信区间：0.24至0.82）。在多变量调整后，寻找第一份工作或失业、BMI以及有鼻炎症状仍然具有显著性。
未控制哮喘与多种决定因素相关。识别这些因素有助于从临床和公共卫生角度改善哮喘护理。
