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Respir Med. 2013 Nov;107(11):1659-66. doi: 10.1016/j.rmed.2013.08.019. Epub 2013 Sep 3.

Assessment of asthma control: the SERENA study.

Author information

  • 1Respiratory Intensive Care Unit and Thoracic Physiopathology, University and General Hospital Careggi, Firenze, Italy. Electronic address: corradoa@aou-careggi.toscana.it.

Abstract

BACKGROUND:

Several studies suggest that many asthmatic subjects have uncontrolled asthma. The control of asthma is now considered the major goal of therapy.

OBJECTIVES:

to ascertain the level of asthma control, by Asthma Control Test (ACT), in "real-life" clinical practice and the potential risk factors for uncontrolled disease in patients treated with inhaled corticosteroids (ICS) and long-acting beta-adrenergic agonists (LABA).

METHODS:

SERENA is a multi-centre, cross-sectional, 6-month observational, non-interventional study carried out in 16 Pulmonary Units in Italy. Asthmatic outpatients aged over 18, undergoing treatment with ICS at medium-high daily doses associated with LABA, were enrolled. The patients were divided in 3 subgroups according to the level of asthma control by ACT score (25:controlled; 20-24:partly controlled; <20: uncontrolled).

RESULTS:

Out of a total of 548 patients, 396 met the inclusion criteria. Only 9.1% of patients had asthma controlled, while partly controlled and uncontrolled asthma accounted for 39.6% and 51.3% respectively. The mean age was 54.5 ± 15.8 and the mean duration of asthma was 16.1 ± 14.1 years. There were more females than males (63% vs 37%) and females had highest prevalence of uncontrolled asthma (63.1%). The mean values of FEV1% predicted were lower in the uncontrolled group (p < 0.001). The percentage of patients with at least 1 exacerbation, unscheduled visit and/or admissions was lower in controlled (22.2%, 8.3%, 8.3%) than in partly controlled (50%, 38.6%, 9.2%) and uncontrolled (83.2%, 66.2%, 27.8%) groups (p < 0.0001). The multivariate ordinal logistic regression analysis identified female sex, FEV1 and exacerbations as the strongest independent factors associated with the uncontrolled disease.

CONCLUSION:

This study highlights the importance in clinical practice of a periodic assessment by a validated asthma control instrument and exacerbations/health care contacts during previous year. Clinicians should be aware that a significant proportion of patients can have uncontrolled asthma, despite regular pharmacological treatment.

Copyright © 2013 Elsevier Ltd. All rights reserved.

KEYWORDS:

Asthma control test; Inhaled corticosteroids; International guidelines; Long-acting beta2-agonist; Uncontrolled asthma

PMID:
24045118
[PubMed - indexed for MEDLINE]
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