Publication:

An observational study to assess reasons for lack of control among patients of bronchial asthma attending a tertiary care centre in India

Background Bronchial asthma is a common chronic respiratory ailment affecting both children and adults. Lack of control among asthmatics leads to adverse outcomes and increased health care costs. Studies from India evaluating level of control and reasons for inadequate control are lacking. Objective was to assess level of control and reasons for partly/poorly controlled asthma.

Methods Consecutive patients of bronchial asthma (>8 weeks on treatment) presenting to a tertiary care centre and consenting for participation in the study were enrolled. Control was assessed used global initiative for asthma (GINA) guidelines and patients categorised into poor, partly or well control.1 Enrolled patients were assessed by a questionnaire to record their demographic details including body mass index (BMI), duration of disease, smoking status, environmental smoke exposure/biomass fuel exposure, adherence to therapy, technique of inhaled medication and anxiety/depression, co morbidities including allergic rhinitis, gastro-oesophageal reflux (GER) symptoms, obstructive sleep apnoea (OSA) and allergic bronchopulmonary aspergillosis were also assessed.

Results 150 consecutive patients, 58% females and 42% males with mean age of 40.03±14.77 years were enrolled. 19.3% of patients were well controlled while 50.7% were poorly and 30% were partly controlled. On comparing well controlled versus uncontrolled asthma (poor and partly controlled) adherence, device technique of inhaled medication, depression scores and eosinophilia showed a significant association. On application of logistic regression model, depression scores, inhaler adherence and device technique were associated with level of control.

Conclusions Asthma is partly/poorly controlled in majority of asthmatics. Psychiatric co-morbidities, adherence to therapy and correct device technique are major reasons for partly/poorly controlled asthma. Addressing these modifiable factors can improve level of control among asthmatics.