Health care education, delivery, and quality
Real-world Evaluation of Asthma Control and Treatment (REACT): Findings from a national Web-based survey

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Background

Despite health initiatives for advancing the management of asthma, evidence suggests that many asthmatic subjects have uncontrolled disease. However, the prevalence of uncontrolled asthma in the United States is not known and has not been fully characterized.

Objective

We sought to assess the prevalence, morbidity, and factors associated with uncontrolled asthma in a nationally representative sample of patients with moderate-to-severe asthma using standard asthma medications.

Methods

A Web-based survey was administered to patients with diagnoses of asthma for at least 1 year who were receiving multiple controller medications. The Asthma Control Test score was used to stratify respondents into controlled and uncontrolled cohorts.

Results

A total of 1812 patients were assessed; 809 (45%) had controlled asthma, and 1003 (55%) had uncontrolled asthma. Most patients had health care coverage and received care from a general practitioner; a large proportion of patients with controlled asthma (74%) and patients with uncontrolled asthma (65%) reported never receiving an asthma action plan. Inhaled corticosteroid plus long-acting β-agonist was the most common medication regimen in patients with controlled asthma (60%) and patients with uncontrolled asthma (48%) patients. Patients with uncontrolled asthma reported significantly higher rates of health care use. Several comorbidities were predictive of uncontrolled asthma.

Conclusion

Uncontrolled asthma is highly prevalent (55%) in patients using standard asthma medications. There is need for improved asthma care in patients with moderate-to-severe asthma, including a global evaluation of asthma control, implementation of treatment plans and asthma control tests, and addressing comorbid conditions.

Clinical implications

Improved asthma care requires broader assessments of asthma control, including asthma-related health care and medication use, comorbidities, and the implementation of treatment plans and formal asthma control tests.

Section snippets

Greenfield Online

Greenfield Online is a primary research company that maintains global research panels for the purpose of executing research studies for nonprofit and for-profit companies, government agencies, and academic organizations. The Greenfield Online panel is among the largest Web-based survey cohorts in the world, containing nearly 4 million participants in the United States.5 Members voluntarily opt into Greenfield Online and are recruited from a diverse pool of sources, including Internet portals,

Univariate analysis

A total of 1812 patients were included in this study; of these patients, 809 (45%) had controlled asthma, and 1003 (55%) had uncontrolled asthma. Demographics and disease characteristics for these patients are shown in Table II. Patients with controlled and uncontrolled asthma were similar with regard to age, race/ethnicity, and type of residence. A higher proportion of female than male patients was seen in both groups, but among male patients, a higher proportion was in the uncontrolled group.

Discussion

To our knowledge, the REACT study is the first to assess the prevalence of uncontrolled asthma in the United States in a nationally representative sample of asthma patients taking standard asthma medications. It is also the first study to use multivariable analyses to examine factors associated with uncontrolled disease in a nationally representative sample of treated American asthma patients. Because patients with more severe asthma confer the highest economic burden in asthma care,12, 13 we

References (42)

  • A. Apter et al.

    Advances in adult and pediatric asthma

    J Allergy Clin Immunol

    (2006)
  • M.K. Miller et al.

    Severity assessment in asthma: an evolving concept

    J Allergy Clin Immunol

    (2005)
  • J.G. Teeter et al.

    Relationship between airway obstruction and respiratory symptoms in adult asthmatics

    Chest

    (1998)
  • National Institutes of Health

    Guidelines for the diagnosis and management of asthma: update on selected topics 2002

    (2002)
  • American Lung Association, Epidemiology and Statistics Unit, Research and Program Services. Trends in asthma morbidity...
  • Asthma in America: a landmark survey. Executive summary. Research Triangle Park (NC): GlaxoWellcome. Available at:...
  • Greenfield Online Panel. 2004-2005. Available at: http://www.greenfield.com/rcpanelbook.htm. Accessed November 30,...
  • A. Wilson et al.

    Internet based marketing research: a serious alternative to traditional research methods?

    Marketing Intell Plann

    (2003)
  • Nielson Net Ratings. Enumeration study, February 2004. Available at: http://www.nielson-netratings.com/pr_040318.pdf....
  • M. Szklo et al.

    Epidemiology, beyond the basics

    (2000)
  • J.A. Last

    A dictionary of epidemiology

    (2001)
  • Cited by (0)

    Supported by Genentech, Inc, South San Francisco, Calif.

    Disclosure of potential conflict of interest: S. P. Peters has consulting arrangements with and is on the speakers' bureau for Genentech and Novartis. C. A. Jones has consulting arrangements with Genentech, Merck, Sanofi-Aventis, and AstraZeneca; has received grant support from Genentech and Merck; and is on the speakers' bureau for Genentech, Merck, Sanofi-Aventis, and AstraZeneca. T. Haselkorn has consulting arrangements with Genentech. D. R. Mink is employed by Ovation Research Group, which receives grant support from Genentech. D. J. Valacer owns stock in Genentech and General Electric and is employed by Genentech. S. T. Weiss has consulting arrangements with Glaxo-Wellcome, Roche Pharmaceuticals, Millennium Pharmaceuticals, Genentech, Schering-Plough, Variageics, Genome Therapeutics, and Merck Frost and has received grant support from Glaxo-Wellcome, AstraZeneca, and Pfizer.

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