Number of treatable traits associated with asthma control, quality of life

Key takeaways:

• Patients had an average of 3 ± 1.8 treatable traits.
• Only 7% of patients had no treatable traits.
• 33% of patients were referred to a specialized nurse.

The number of treatable traits patients have that do not require pharmacological care was associated with asthma control and quality of life, according to a study published in The Journal of Allergy and Clinical Immunology: In Practice.

However, referrals to nonmedical professionals to treat these traits are scarce, Steffi M.J. Janssen, MSc, of the department of pulmonary rehabilitation at the Basalt Rehabilitation Centre, Leiden, the Netherlands, and colleagues wrote.

The observational, retrospective study involved 444 adults (57% women; mean age, 48 years; standard deviation, 16) with a mean FEV₁ of 88% ± 17% predicted.

Based on Asthma Control Questionnaire (ACQ) and Asthma Quality of Life Questionnaire (AQLQ) scores, 233 (53%) had uncontrolled asthma and decreased quality of life. Also, the researchers measured the prevalence of nine treatable traits, including:

• severe fatigue, 60%;
• physical inactivity, 53%;
• decreased exercise capacity, 40%;
• frequent exacerbations, 30%;
• hyperventilation, 30%;
• overweight, 28%;
• severe dyspnea, 20%;
• depressive mood, 20%; and
• current smoking, 15%.

Also, 7% had none of these traits, 16% had one, 21% had two, 19% had three, 16% had four, 12% had five, 5% had six, 2% had seven and 1% had eight. No patients had all nine traits. The average was three ± 1.8 traits per patient. Additionally, 19% of the patients who had none of these traits had uncontrolled asthma.

As asthma control got worse, the number of treatable traits increased. Patients with controlled asthma had 1.6 ± 1.3 traits (18%), those with partially controlled asthma had 2.3 ± 1.4 traits (26%) and those with uncontrolled asthma had 3.6 ± 1.8 traits (40%; P < .001).

Similarly, patients with decreased quality of life had 3.4 ± 1.8 traits (38%), whereas those with good quality of life had 1.7 ± 1.2 traits (19%; P < .01).

There was a weak correlation between the number of traits and FEV₁ (rho = 0.12; P = .01), the researchers said, as well as moderate correlations between the number of traits and ACQ (rho = 0.49; P < .01) and AQLQ (rho = 0.56; P < .01) scores.

Further, the researchers found significant odds ratios for uncontrolled asthma and fatigue (OR = 3; 95% CI, 1.9-4.7), frequent exacerbations (OR = 2.8; 95% CI, 1.7-4.7), severe dyspnea (OR = 2.5; 95% CI, 1.3-5.1), overweight (OR = 2.4; 95% CI, 1.4-4.1) and decreased exercise tolerance (OR = 2.2; 95% CI, 1.3-3.5; P .01 for all).

Odds for impaired quality of life were highest for patients with severe dyspnea (OR = 5.1; 95% CI, 1.5-17.6), severe fatigue (OR = 4.6; 95% CI, 2.7-7.9), frequent exacerbations (OR = 2.8; 95% CI, 1.4-5.5) or overweight (OR = 2.2; 95% CI, 1.1-4.3; P .05 for all) as well.

When the researchers examined a random sample of 95 of these patients, they found that 33% of them were referred to a specialized nurse when one of these traits was detected. Other referrals included physiotherapists (20%), general practice-based nurse specialists (6%), smoking cessation therapy (5%), dieticians (5%), psychologists (2%) and pulmonary rehabilitation (1%). Patients who were referred to a nonmedical health care professional had an average of 3.8 ± 1.7 (42%) traits.

Based on these findings, the researchers concluded that there were associations between the number of treatable traits that patients with asthma may have and their asthma control and quality of life. However, they continued, infrequent referrals to nonmedical professionals to treat these traits leave patients with a high burden of disease.

The researchers recommended more structural screenings for these traits and appropriate referrals to nonmedical professionals to have them addressed. Also, the researchers called for research into effective treatment of these traits, including interviews with asthma providers and general practitioners to uncover why referrals are lacking.