Factors Associated with Asthma Control in Primary Care Patients in Spain: The CHAS study

González Barcala, Francisco Javier; de la Fuente-Cid, Ramón; Álvarez-Gil, Rosa; Tafalla, Mónica; Nuevo, Javier; Caamaño-Isorna, Francisco

doi:10.1016/S1579-2129(10)70085-9

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Abstract

Introduction

Asthma control has been found to be inadequate in all populations studied to date and accounts for the majority of costs for this disease. The objective of our study was to evaluate the prevalence of poorly-controlled asthma in primary care patients and to identify some of the factors associated with this situation.

Methods

We conducted a transversal study that included asthmatic patients over 18 years of age who were monitored in primary care visits (n = 2159). Asthma control was evaluated using the Asthma Control Questionnaire. The demographic variables and the adherence to therapy were evaluated using a questionnaire. The OR for poorly controlled asthma was calculated using logistic regression using asthma control as the dependent variable, which was assessed using the ACQ score.

Results

The prevalence of uncontrolled asthma was 63.8%. Risk factors for poorly-controlled asthma were treatment with oral corticosteroids (OR = 6.55), greater severity of asthma (OR = 3.11), the presence of a recent stressful event (OR = 2.44), a lesser importance given to compliance with therapy (OR = 1.66) and living in rural areas (OR = 1.29). In contrast, sex, age, obesity, smoking, alcohol consumption and educational level did not show any influence over asthma control.

Conclusions

Asthma remains poorly controlled in Spain but some of the factors related to this situation could be changed by the healthcare system.

Keywords:

Asthma

Epidemiology

Primary care

Risk factors

Resumen

Introducción

El control del asma es inadecuado en todas las poblaciones estudiadas hasta el momento actual, generando la mayor parte de los costes de la enfermedad. El obejtivo de nuestro estudio fue evaluar la prevalencia de asma mal controlada en pacientes de atención primaria, e identificar algunos factores asociados con este hecho.

Métodos

Llevamos a cabo un estudio transversal, incluyendo pacientes asmáticos mayores de 18 años, seguidos en consultas de atención primaria (n = 2159). El control del asma se evaluó con el cuestionario “Asthma Control Questionnaire”. Las variables sociodemográficas y el cumplimiento terapéutico se evaluaron mediante un cuestionario. Mediante regresión logística se calcularon los OR de asma mal controlada; utilizando como variable dependiente el control del asma, valorado de acuerdo a la puntuación ACQ.

Resultados

La prevalencia de asma no controlada fue del 63,9%. El tratamiento con corticoides orales (OR = 6,55), la mayor gravedad del asma (OR = 3,11), la presencia de un evento estresante reciente (OR = 2,44), una menor importancia otorgada al cumplimiento terapéutico (OR = 1,66) y vivir en un medio rural (OR = 1,29) fueron factores de riesgo para asma mal controlada. Por el contrario, el sexo, la edad, la obesidad, el tabaquismo, el consumo de alcohol y el nivel educacional no mostraron ninguna influencia sobre el control del asma.

Conclusiones

En España el asma permanece mal controlada, y algunos de los factores relacionados con esta situación podrían ser modificables desde el sistema sanitario.

Palabras clave:

Asma

Epidemiología

Atención Primaria

Factores de riesgo

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