Asthma and lower airway disease
Phenotypic determinants of uncontrolled asthma

https://doi.org/10.1016/j.jaci.2009.06.010Get rights and content

Background

Although uncontrolled asthma remains frequent, determinants of asthma control are poorly studied.

Objectives

The aim was to estimate the distribution and the phenotypic characteristics of asthma control in 2 groups of subjects defined by the use of inhaled corticosteroids (ICS) in the past 12 months, in the Epidemiological study on the Genetics and Environment of Asthma, bronchial hyperresponsiveness and atopy (EGEA).

Methods

Five hundred one adult current patients with asthma who participated in the follow-up of the EGEA study were included. Asthma control was assessed from survey questions reflecting asthma control, as defined in the 2006 Global Initiative for Asthma guidelines. The factors analyzed were age, sex, educational level, body mass index, active and passive smoking, sensitization to aeroallergens, total IgE, rhinitis, chronic cough/phlegm, and age at asthma onset. Analyses were stratified according to ICS use.

Results

Uncontrolled asthma was more frequent in ICS users (27.6%, 35.0%, and 37.4% with controlled, partly-controlled, and uncontrolled asthma respectively) compared with non-ICS users (60.0%, 23.9%, and 16.1%, respectively). In ICS users, chronic cough or phlegm and female sex were independently and significantly related to uncontrolled asthma. In non-ICS users, high total IgE and sensitization to molds were associated with uncontrolled asthma. Smoking and rhinitis were not associated with asthma control.

Conclusion

Optimal asthma control remained unachieved in the majority of patients with asthma in this study. Factors associated with uncontrolled asthma were different in ICS users (chronic cough/phlegm, female sex) and non-ICS users (high total IgE and sensitization to molds).

Section snippets

Population

This is a cross-sectional study using data from the case control and family-based EGEA2 study, the 12-year follow-up of the EGEA1 study. Protocol and descriptive characteristics of the EGEA1 study have been previously published.15, 16 Briefly, 2047 subjects were enrolled at baseline, including 388 children (<16 years) and adult patients with asthma from chest clinics, their 1244 first-degree relatives, and 415 population-based controls. Approximately 10 years later, this population was

Description of the population

Main personal, sociodemographic, and clinical characteristics of the population with asthma are presented in Table I. The mean age of the population was 39 years, and half of the subjects were nonsmokers and not exposed to tobacco smoke at the time of the survey. Regarding allergic phenotypes, 60.2% reported allergic rhinitis, 61.3% had total IgE ≥100 IU/mL, and 80.8% were sensitized to any of the 11 allergens. Chronic cough or phlegm was reported by 16% of the subjects. Patients with asthma

Discussion

Less than half (44%) of this population of patients with asthma participating in the phase 2 of the EGEA study had a controlled asthma, on the basis of characteristics of asthma control as defined in the current GINA guidelines. The proportion of controlled asthma was lower in ICS users, in whom only one fourth of the asthmatics had a controlled asthma. The determinants for uncontrolled asthma were different in ICS users and non-ICS users. In ICS users, chronic cough or phlegm and female sex

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    Supported by grants from Merck Sharp & Dohme (MSD); Hospital program of clinical research (PHRC)-Paris; National Research Agency - Health environment, health-work program; National Research Agency (ANR)- Biological collections for health program; French Agency of health safety, environment and work (AFSSET) and the Isere committee against respiratory diseases (COMARES).

    Disclosure of potential conflict of interest: C. Pison has served as a consultant for GlaxoSmithKline, Boehringer Ingelheim France, AstraZeneca, Nutricia, Numico, and Actéllion and has received research support from AB Science. The rest of the authors have declared that they have no conflict of interest.

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