The control of asthma in real life: Baseline evaluation of a long-term study

Background and Aim Data about patients with asthma frequently derived from randomized-controlled trials that, however, do not represent the real life. We have evaluated the control of asthma in a population referred to a third-level clinic, in a follow-up of 5 years; this part of the study considers the baseline evaluation. Methods Anthropometric characteristics, smoking status, occupational risk, presence of atopy, rhinosinusitis (RS) and gastroesophageal reflux disease (GERD), bronchial inflammation (FeNO), airway hyperreactivity (AH), questionnaires (ACT) were recorded. Accordingly, we divided patients as Controlled (C), Partially Controlled (PC) and Not Controlled (NC). Results 750 patients (62% males; mean age 44 y; mean FEV 1 93% of pred.) were enrolled. 41% had a family history of asthma with an occupational risk identified in 34%. 16% were current smokers, while 27% were former smokers. 42% reported dyspnea, 29% and 24% diurnal and nocturnal symptoms, respectively. Symptoms/signs compatible with RS and GERD were present in 15% and 22%, respectively. The AH was defined as severe (14%), moderate (45%), and mild (41%). The median FeNO and ACT scores were 24 and 22, respectively. Finally, patients were PC (59%), NC (24%), and C (17%). In a multivariate logistic model, the presence of RS increases the risk of having PC/NC patients (OR 2.09, 95% IC 1.25 to 3.49, p=0.005). Conclusion Our study in real life in a cohort of outpatients asthmatics shows: a ) the low prevalence of patients with a complete disease control; b ) the high prevalence of patients with a smoking habit; c ) the co-existence of important comorbidities such as rhinosinusitis and GERD. Rhinosinusitis can increase the poor control of asthma.