Abstract
Background: Many studies in children had identified risk factors associated with partly or uncontrolled asthma. In adults, factors related to asthma control were not well defined.
Objective: To find the factors related to partly or uncontrolled asthma in adults.
Methods: Asthmatic adults who had severity at least in the mild persistent level, were recruited. The asthma control levels were classified as controlled, partly controlled and uncontrolled according to the Global Initiative for Asthma guideline. Risk factors were compared between the patients with controlled and partly controlled/ uncontrolled asthma groups.
Results: two hundred (75.5 % females) were included. The mean age was 38.4 ± 11.93 years old. There were 100 patients (50 %) in the controlled and 100 patients (50 %) in partly controlled and uncontrolled asthma group. For asthma severity, 35 patients (88.2 %) were in mild persistent, 14 patients (10 %) in moderate persistent and 97 patients (1.8 %) in severe persistent groups. The absence of stress yielded an OR = 0.41 (95 % CI = 0.23-0.75), p = 0.03. While active smoking, OR = 4.23 (95 % CI = 1.35-13.2), p = 0.007. Patients who have no contact with stuffed animals or rugs have OR = 0.4 (IC 95 % = 0.2-0.79). It was important the result of the patients that if they correctly use their inhalers OR = 0.36 (IC 95 % = 0.13-0.97), p = 0.031.
Conclusions: Current and active smoking and atopic dermatitis are risk factors. As a protective factor to the normal levels of eosinophils in blood, correct use of inhalers, FEV1 > 80 %, the absence of stress and the absence of contact with carpets and stuffed animals.
References
Prosser R, Carleton B, Smith A. The comorbidity burden of the treated asthma patient population in British Columbia. Chronic Dis Can. 2010;30(2):46-55. Disponible en: https://www.canada.ca/en/public-health/services/reports-publications/health-promotion-chronic-disease-prevention-canada-research-policy-practice/vol-30-no-2-2010/comorbidity-burden-treated-asthma-patient-population-british-columbia.html
Platts-Mills TA, Erwin EA, Heymann PW, Woodfolk JA. Pro: the evidence for a causal role of dust mites in asthma. Am J Respir Crit Care Med. 2009;180(2):109-121. DOI: 10.1164/rccm.200811-1756PR
Tovey E, Ferro A. Time for new methods for avoidance of house dust mite and other allergens. Curr Allergy Asthma Rep. 2012;12(5):465-477. DOI: 10.1007/s11882-012-0285-0
Gershon AS, Wang C, Guan J, To T. Burden of comorbidity in individuals with asthma. Thorax. 2010;65(7):612-618. DOI: 10.1136/thx.2009.131078
Global Strategy for Asthma Management and Prevention. EE. UU.: Global Initiative for Asthma (GINA); 2018. Disponible en: https://ginasthma.org/wp-content/uploads/2018/04/wms-GINA-2018-report-V1.3-002.pdf
National Asthma Education and Prevention Program. Expert Panel Report 3. Guidelines for the diagnosis and management of asthma. EE. UU.: Department of Health and Human Services/National Institutes of Health/National Heart, Lung, and Blood Institute; 2007. Disponible en: https://www.nhlbi.nih.gov/files/docs/guidelines/asthgdln.pdf
British Thoracic Society/Scottish Intercollegiate Guidelines Network. British Guideline on the Management of Asthma. Escocia: British Thoracic Society/Scottish Intercollegiate Guidelines Network; 2008. Disponible en: https://www.brit-thoracic.org.uk/document-library/clinical-information/asthma/btssign-asthma-guideline-2008/
Cazzola M, Calzetta L, Bettoncelli G, Novelli L, Cricelli C, Rogliani P, et al. Asthma and comorbid medical illness. Eur Respir J. 2011;38(1):42-49. DOI: 10.1183/09031936.00140310
Antunes J, Fernandes A, Miguel-Borrego L, Leiria-Pinto P, Cavaco J. Cystic fibrosis, atopy, asthma and ABPA. Allergol Immunopathol (Madr). 2010;38(5):278-284. DOI: 10.1016/j.aller.2010.06.002
Vandenplas O, Dramaix M, Joos G, Louis R, Michils A, Verleden G, et al. The impact of concomitant rhinitis on asthma-related quality of life and asthma control. Allergy. 2010;65(10):1290-1297. DOI: 10.1111/j.1398-9995.2010.02365.x
Thilsing T, Rasmussen J, Lange B, Kjeldsen AD, Al-Kalemji A, Baelum J. Chronic rhinosinusitis and occupational risk factors among 20- to 75-year-old Danes: a GA2LEN-based study. Am J Ind Med. 2012;55(11):1037-1043. DOI: 10.1002/ajim.22074
Jarvis D, Newson R, Lotvall J, Hastan D, Tomassen P, Keil T, et al. Asthma in adults and its association with chronic rhinosinusitis: the GA2LEN survey in Europe. Allergy. 2012;67(1):91-98. DOI: 10.1111/j.1398-9995.2011.02709.x
Franco-Marina F, Fernández-Plata R, Torre-Bouscoulet L, García-Sancho C, Sánchez-Gallen E, Martínez D, Pérez-Padilla R. Efficient screening for COPD using three steps: a cross-sectional study in Mexico City. NPJ Prim Care Respir Med. 2014;24:14002. DOI: 10.1038/npjpcrm.2014.2
Abramson MJ, Puy RM, Weiner JM. Injection allergen immunotherapy for asthma. Cochrane Database Syst Rev. 2010;(8):CD001186. DOI: 10.1002/14651858.CD001186.pub2
Chipps BE, Zeiger RS, Borish L, Wenzel SE, Yegin A, Hayden ML, et al. Key findings and clinical implications from The Epidemiology and Natural History of Asthma: Outcomes and Treatment Regimens (TENOR) study. J Allergy Clin Immunol. 2012;130(2):332-342. DOI: 10.1016/j.jaci.2012.04.014
Harris M, Lundien M, Finnie D, Williams A, Beebe T, Sloan J, et al. Application of a novel socioeconomic measure using individual housing data in asthma research: an exploratory study. NPJ Prim Care Respir Med. 2014;24:14018. DOI: 10.1038/npjpcrm.2014.18
Halimi L, Pry R, Pithon G, Godard P, Varrin M, Chanez P. Severe asthma and adherence to peak flow monitoring: longitudinal assessment of psychological aspects. J Psychosom Res. 2010;69(4):331-340. DOI: 10.1016/j.jpsychores.2010.02.007
Just J, Gouvis-Echraghi R, Couderc R, Guillemot-Lambert N, Saint-Pierre P. Novel severe wheezy young children phenotypes: boys atopic multiple-trigger and girls nonatopic uncontrolled wheeze. J Allergy Clin Immunol. 2012;130(1):103-110. DOI: 10.1016/j.jaci.2012.02.041
Sánchez J, Diez S, Cardona R. Frequency of sensitization to animals in a tropical area. Rev Alerg Mex. 2014;61(2):81-89. DOI: 10.29262/ram.v61i2.30
Brozek JL, Bousquet J, Baena-Cagnani CE, Bonini S, Canonica GW, Casale TB, et al. Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines: 2010 revision. J Allergy Clin Immunol. 2010;126(3):466-476. DOI: 10.1016/j.jaci.2010.06.047
Bousquet J, Addis A, Adcock I, Agache I, Agusti A, Alonso A, et al. Integrated care pathways for airway diseases (AIRWAYS-ICPs). Eur Respir J. 2014;44(2):304-323. DOI: 10.1183/09031936.00014614
Portelli MA, Hodge E, Sayers I. Genetic risk factors for the development of allergic disease identified by genome wide association. Clin Exp Allergy. 2014;45(1):21-31. DOI: 10.1111/cea.12327
Haldar P, Pavord ID, Shaw DE, Berry MA, Thomas M, Brightling CE, et al. Cluster analysis and clinical asthma phenotypes. Am J Respir Crit Care Med. 2008;178(3):218-224. DOI: 10.1164/rccm.200711-1754OC
Amelink M, De Nijs SB, Berger M, Weersink EJ, Ten-Brinke A, Sterk PJ, et al. Nonatopic males with adult onset asthma are at risk of persistent airflow limitation. Clin Exp Allergy. 2012;42(5):769-774. DOI: 10.1111/j.1365-2222.2012.03977.x
Reponen T, Levin L, Zheng S, Vesper S, Ryan P, Grinshpun SA, LeMasters G. Family and home characteristics correlate with mold in homes. Environ Res. 2013;124:67-70. DOI: 10.1016/j.envres.2013.04.003
Eichenfield LF, Tom WL, Chamlin SL, Feldman SR, Hanifin JM, Simpson EL, et al. Guidelines of care for the management of atopic dermatitis: section 1. diagnosis and assessment of atopic dermatitis. J Am Acad Dermatol. 2014;70(2):338-351. DOI: 10.1016/j.jaad.2013.10.010
Lai CK, Beasley R, Crane J, Foliaki S, Shah J, Weiland S, et al. Thorax. 2009;64(6):476-483. DOI: 10.1136/thx.2008.106609
Koh YY, Kim CK. Desarrollo de asma en pacientes con rinitis alérgica. Curr Opin Allergy Clin Immunol. 2003;3(3):159-164.
Reddel HK, Taylor DR, Bateman ED, Boulet LP, Boushey HA, Busse WW, et al. An official American Thoracic Society/European Respiratory Society statement: asthma control and exacerbations: standardizing endpoints for clinical asthma trials and clinical practice. Am J Respir Crit Care Med. 2009;180(1):59-99. DOI: 10.1164/rccm.200801-060ST
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