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Most Patients With Moderate to Severe Asthma Have Suboptimal Control: Presented at AAAAI

By Paula Moyer

SAN DIEGO, CA -- March 1, 2007 -- Most patients with moderate to severe asthma in the United States live with poorly controlled disease, according to investigators who presented the results of the Real-world Evaluation of Asthma Control and Treatment (REACT).

The results presented the findings here on February 25^th at the American Academy of Allergy, Asthma, and Immunology (AAAAI) annual meeting.

"A high rate of uncontrolled asthma and healthcare utilisation was observed, despite evidence of patients receiving care in accordance with currently accepted guidelines," said principal investigator Stephen P. Peters, MD, PhD, professor of medicine and paediatrics, divisions of pulmonary, critical care, allergy, and immunology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, United States.

Dr. Peters and coinvestigators assessed the prevalence of and the risk factors for uncontrolled asthma in a nationally representative population of people with moderate to severe asthma who were on treatments that met the current standard of care.

Eligible participants were using at least 2 long-term controller medications, such as an inhaled corticosteroid and a long-acting beta-agonist, and either had taken at least 2 courses of oral steroids in the past year or were using a short-acting beta-agonist.

Participants had responded to a web-based survey and consisted of a census-representative sample of adults, 18 years old or more, who had moderate to severe asthma that had been diagnosed at least 1 year previously. The investigators used the Asthma Control Test (ACT) to stratify respondents into controlled or uncontrolled asthma. Those with controlled disease had ACT scores of 20 to 25, and those with uncontrolled disease had ACT scores of 5 to 19.

Of the 1,812 patients who were evaluated, 55% had uncontrolled asthma. There was no difference in insurance coverage between these 2 groups, with 88% of controlled and 86% of uncontrolled asthma patients having insurance coverage. Most patients in both groups received care for their asthma from a general practitioner (69.3% and 68.6%, respectively). In these 2 groups, 74% and 65% said they had never received an asthma action plan.

The most common treatment regimen was an inhaled corticosteroid and a long-acting beta-agonist, which was used in 60% of those with controlled disease and in 48% of those with uncontrolled disease.

Patients with uncontrolled asthma reported significantly higher rates of healthcare use, with more frequent unscheduled physician visits, emergency room visits, hospitalisations, and missed days of work or school in the previous year (P < .001 for all). They were also more likely to have gastrooesophageal reflux disease (GERD, P = .01), chronic sinusitis (P = .02), and hypertension (P = .01), factors that the investigators concluded were predictive of uncontrolled asthma.

"The findings underscore the need for improved asthma care, including a more global evaluation of asthma control, implementation of treatment plans, and assessment of comorbid conditions for controlling disease in patients with moderate to severe asthma," Dr. Peters said.

REACT is funded by Genentech, Inc., which manufactures omalizumab (Xolair).


[Presentation title: Real-World Evaluation of Asthma Control and Treatment (REACT): Findings From a National Web-Based Survey. Abstract 28]

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