Achieving optimal asthma control and minimizing the risk of exacerbation are the main goals of asthma treatment.
This study aimed to assess the predictors of poor asthma control and asthma exacerbations within a population of moderate to severe asthmatic patients treated in a tertiary care center.
We conducted a cohort study assessing 738 patients enrolled in the Quebec registry in respiratory health (RESP) with a diagnosis of asthma confirmed by a respirologist and treated in a tertiary care center from April 2010 to March 2016. Sociodemographic and clinical data, including ACQ score, were collected at enrolment in the registry (i.e. cohort entry) and patients were followed for a two-year period thereafter. The information regarding exacerbations that occurred during follow-up was collected in administrative databases (RAMQ, MED-ECHO and reMed).
738 subjects (64% women) were assessed. Psychological distress (OR: 1.91 [1.21-3.02]), smoking (OR: 3.72 [1.72-8.05]) and poor lung function, FEV<50% (OR: 4.1 [1.48-11.34]) appeared as significant factors associated with uncontrolled asthma. Occurrence of previous asthma exacerbations (HR: 6.25 [4.01-9.75]), poor asthma control (HR:1.60 [1.07-2.38]), FEV between 50% and 80% (HR:2.25 [1.58-3.34]) and older age (HR:2.26[1.37-3.74]) were associated with asthma exacerbations. Adherence to asthma treatment was very low in patients with (44.4 % ± 34.4) and without asthma exacerbations (37.5 % ± 33.0).
Psychological distress and current smoking are modifiable factors that need to be addressed in tailored behavioural interventions to improve asthma control. Asthma exacerbations are mostly associated with the intrinsic severity of the disease.

Copyright © 2021. Published by Elsevier Inc.

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