Chest
Volume 124, Issue 5, November 2003, Pages 1781-1788
Journal home page for Chest

Clinical Investigations
ASTHMA
Causative and Contributive Factors to Asthma Severity and Patterns of Medication Use in Patients Seeking Specialized Asthma Care*

https://doi.org/10.1378/chest.124.5.1781Get rights and content

Study objectives

(1) To assess the prevalence of specific factors considered causative or contributive to asthma in a population of patients seen in a specialized asthma clinic, and to determine whether any of these factors were associated with more severe disease; and (2) to assess the utilization of inhaled steroids by asthma severity in this population and compare it with published guidelines of the National Heart, Lung, and Blood Institute (NHLBI).

Design, setting, and patient population

We conducted a retrospective chart review of new patients seen in a specialized asthma treatment center over a 2.5-year period and recorded the prevalence of 14 causative or contributive factors, the severity of asthma, and the intensity of treatment with inhaled corticosteroids in each patient. Patients were grouped as mild asthma vs moderate/severe asthma and compared by χ2 analysis and stepwise logistic regression to determine whether certain factors were associated with more severe asthma.

Measurements and results

The average number of factors recorded was 2.9 ± 1.8 in the mild group (± SD) and 3.5 ± 1.6 in the moderate/severe asthma group. This difference was statistically significant (p = 0.014). Increasing age, male gender, symptomatic gastroesophageal reflux disease (GERD), and chronic sinusitis were independently associated with more severe asthma. Suboptimal use of inhaled corticosteroids was more common in patients with mild persistent asthma, but suboptimal dosing of inhaled corticosteroids was equally common in mild and moderate/severe asthma. No relationship was found between allergen sensitization combined with exposure to cats, dogs, dust mite, or molds and more severe asthma.

Conclusions

This study confirms earlier studies showing that symptomatic GERD and chronic sinusitis are important comorbid conditions in patients with asthma, both being associated with greater asthma severity. This study further shows that the doses of inhaled corticosteroids used for treatment of asthma fall short of NHLBI guidelines in the majority of patients regardless of asthma severity.

Section snippets

Patient Selection

The study population included all new adult patients initially seen in a regional university-based referral center, The Asthma Center, between the dates of January 1, 1997, and June 18, 1999. Each patient was confirmed to have asthma as defined by the American Thoracic Society, which required demonstration of reversible obstructive airway disease with a ≥ 15% decrement in predicted FEV1 as well as improvement in expiratory flow rates to ≥ 15% of predicted after inhalation of a β2-selective

Results

Between January 1, 1997, and June 18, 1999, a total of 176 patients met the inclusion criteria for the study (initial visit, presenting for asthma, and meeting criteria for diagnosis of asthma). Of these, 27 patients were excluded (17 patients had lung disease other than asthma, 3 patients had congestive heart failure, and 7 patients had other comorbidities). The study population therefore consisted of 149 patients. Of these, 97 patients (65.1%) were female, 135 patients (90.6%) were white, 13

Discussion

The primary objective of this study was to examine causative and contributive factors to asthma severity in a population of patients referred to a university-based asthma center, with the hypothesis that certain factors or a greater number of factors might be associated with more severe disease. We found that patients with moderate/severe asthma have a significantly greater overall prevalence of causative and contributive factors and were more likely to be male than female. We also confirmed

ACKNOWLEDGMENT

The authors thank Dr. Jay F. Piccirillo for assistance in study design, and Mrs. Kristy Smith for preparation of the manuscript.

Cited by (30)

  • The Allergic Asthma Phenotype

    2014, Journal of Allergy and Clinical Immunology: In Practice
    Citation Excerpt :

    Patients with allergy and with asthma may be classified as having “few, moderate, or high” symptoms,11 and cohorts of difficult-to-control or severe asthma include individuals with allergy.12-14 However, studies of patients with varying degrees of asthma severity report that allergic versus nonallergic asthma is less severe1,2,5,15-18 or that there is no association between severity and atopic status.19-22 Other reports suggest that patients with allergic versus nonallergic asthma have less need for oral glucocorticosteroids.1,2

  • Severe Asthma in Adults. An Orphan Disease?

    2012, Clinics in Chest Medicine
    Citation Excerpt :

    An important issue in severe asthma is the presence of comorbidities, including mainly rhinosinusitis, gastroesophageal reflux disease (GERD), obstructive sleep apnea, hormonal disorders, and psychopathologies.33 Many of these conditions share common pathophysiologic mechanisms with asthma, influence the response to treatment, and lead to poor asthma control.39–41 The presence of these comorbidities was associated with the frequent-exacerbations phenotype of severe asthma in the Leiden cohort.20

  • Chronic rhinosinusitis: Epidemiology and medical management

    2011, Journal of Allergy and Clinical Immunology
    Citation Excerpt :

    The presence of bacterial biofilm was also strongly associated with persistent mucosal inflammation after endoscopic sinus surgery.57 Liou et al58 examined causes and contributive factors to asthma severity in 149 asthmatic patients at an asthma specialty clinic and found that CRS was associated with more severe asthma (OR, 2.22; 95% CI, 1.08-4.60; P = .032). In a study in western Sweden, Lotvall et al59 found an association between the presence of CRS and multisymptom (more severe) asthma by using the OLIN and GA2LEN respiratory- and allergy-focused questionnaires, whereas no association was found with allergic rhinitis.

  • Gastroesophageal Reflux Disease

    2010, Sleisenger and Fordtran’s Gastrointestinal and Liver Disease- 2 Volume Set: Pathophysiology, Diagnosis, Management, Expert Consult Premium Edition - Enhanced Online Features and Print
  • Characterization of the severe asthma phenotype by the National Heart, Lung, and Blood Institute's Severe Asthma Research Program

    2007, Journal of Allergy and Clinical Immunology
    Citation Excerpt :

    Aspirin sensitivity, GERD, sinusitis, and pneumonia were reported more often in severe asthma. These results support smaller studies that have used similar methods of self-report to estimate prevalence of comorbid diseases in severe asthma.19,34-37 In our study, nearly 2/3 of the severe group reported a history of pneumonia and, except for baseline FEV1 % predicted, pneumonia was the strongest independent predictor of severe asthma (OR, 3.30).

View all citing articles on Scopus
View full text