O17-3: Reasons for uncontrolled asthma in patients attending a difficult-to-treat asthma clinic
Page Source : https://onlinelibrary.wiley.com/doi/10.1111/resp.14149_100
Chee Kuan Wong, Thian Chee Loh, Hui Li Law, Nur Husna Ibrahim, Chong Kin Liam, Yong Kek Pang, Mau Ern Poh, Jiunn Liang Tan, Chun Ian Soo, Ka Kiat Chin, Vijayan Munusamy, Leng Cheng Sia
University of Malaya, Malaysia, AstraZeneca Sdn Bhd, Malaysia, Malaysia
Background and Aims: Reasons for uncontrolled asthma are many. We aim to identify the reasons for uncontrolled asthma in patients attending our newly established difficult-to-treat asthma clinic.
Methods: 214 patients attended our difficult-to-treat asthma clinic from 25/09/2020 to 30/04/2021 and had their Asthma Control Test (ACT) and Reliever Reliance Test (RRT) scores measured. 52 patients had an ACT score ≤16 consistent with uncontrolled asthma.
Results: Of the 52 patients [mean (+SD) age, 52 (±16.8) years], the majority were females (76.9%). 75% of them were overweight [mean BMI = 29.1 (±6.28) kg/m2]. 21(40.4%) had ≥3 co-morbidities. Most were never-smokers (86.5%) and on GINA step 5 treatment (73.1%). Of the 27 (51.9%) patients who had their inhaler technique assessed, 8 (29.6%) had poor inhaler technique. Treatment adherence was checked in 47 (90.4%) patients and 14 (29.8%) admitted to poor adherence to preventer therapy. Uncontrolled asthma [mean ACT score, 12.33 (±2.98)] significantly correlated with overreliance on reliever therapy [mean RRT score, 15.92 (± 4.58), p< 0.05] with 28 patients (53.8%) using an inhaled reliever >2 times per week. Only 20 patients (38.5%) truly had severe asthma after excluding other reasons for uncontrolled asthma such as poor adherence (23.1%), co-morbidities (15.3%), poor inhaler technique (5.8%) and ongoing triggers (3.8%). 7 patients (13.5%) did not have a concluded reason for their uncontrolled asthma due to incomplete assessment.
Conclusions: Overreliance of reliever and poor adherence to preventer therapy are the major reasons for uncontrolled asthma. Lack of inhaler technique assessment is one of the contributing factors.
