Factors Influencing Asthma Course and the Degree of Control in the Patients Assessed with Own Questionnaire and Asthma Control Test (ACT)

Introduction: Asthma treatment requires control and monitoring. According to Global Initiative For Asthma (GINA) asthma severity is described by degree of control. The aim of the present study was to compare self-patients’ opinions about asthma control with Asthma Control Test (ACT) scores. Furthermore factors associated with asthma control were analyzed in the examined group of patients. Age, BMI, the length and the degree of asthma treatment, concomitant diseases, physical activity, exposition to the tobacco smoke, needs for education and self-control were assessed. Material and methods: The study was based on a 36-point questionnaire that evaluated last two years of asthma duration, the reference data were obtained by objective evaluation with ACT. Fifty three patients, 37 women and 16 men, median age 54 years (24–80 years), from outpatients clinic were enrolled into the study. According to ACT score the patients (pts) were divided into 3 groups: 25 points—well controlled asthma (group 1), 20–24 points—partially controlled asthma (group 2) and less than 20 points—lack of asthma control (group 3). Kruskal-Wallis test and Chi-square test were used to compare the characteristics of subjects in different ACT groups. Pearson’s test was used for assessment of correlation between different parameters. Results: Twenty seven of 53 pts (51%) were treated with low dose of inhaled steroids and long acting beta-agonists (third degree of treatment according to GINA). During last two years the treatment was intensified in 37 pts (70%) due to exacerbation, and 19 of them (36%) were hospitalized in the course of exacerbation. Although 36 out of 53 pts (68%) claimed their asthma was fully controlled, ACT showed full control only in 5/53 (9%) of cases, partial control in 18/53 (34%), lack of control—in 30/53 (57%). Older age (p < 0.05) and longer duration of the disease (p < 0.01) were the factors significantly influencing lack of asthma control. A tendency towards worse asthma control was combined also with overweight and greater number of concomitant diseases (mainly coronary artery disease, diabetes and gastro-esophageal reflux). The presence of influenza vaccinations in medical history was associated with better asthma control (p = 0.05). Conclusions: A discrepancy between subjective assessment of asthma control and ACT score was observed in the examined group of patients. The frequency of asthma exacerbations (according to questionnaire) was describing the degree of asthma control more precisely than self-assessment. Older age and longer disease duration were combined with significantly worse asthma control. Better asthma control was combined with the presence of influenza vaccinations in medical history.