Disease control in general practice patients with asthma

Objectives: To examine asthma control in conjunction with medication use in asthma patients from general practice. To determine features of patients with inadequately controlled asthma. Methods: A cross-sectional study was performed among 661 adult asthma patients recruited from general practice. Disease control was defined by: (1) respiratory symptoms; (2) forced expiratory volume in 1 s (FEV1)% predicted; (3) PEF variability; and (4) the use of β2-agonists. Medical treatment was categorised according to the step-care therapy rules following the 1997 guideline of the Dutch College of General Practitioners (DDGP). Results: Of the 661 asthma patients studied, 262 (40%) had a good disease control, 84 (13%) a mildly reduced, 235 (36%) a moderately reduced, and 80 (12%) had a poor disease control. Of the 399 patients (60%) inadequately controlled, in 292 patients (44%) adequate control might be achieved by changing treatment, in 99 patients (15%) adequate control might not completely be achieved by changing treatment, and 8 (1%) were already maximally treated. Compared to patients with a good disease control, patients inadequately controlled were usually older, less educated, younger at onset of pulmonary complaints, and in addition had more severe dyspnea and poorer health-related quality of life (HRQoL). Conclusion: Using our criteria, a substantial proportion of asthma patients primarily treated in general practice is not adequately controlled. Assessing patients' disease control together with the level of medical treatment may help to gain insight into the effectiveness of current disease management.