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ICD Code: 493. Asthma

ICD Code: 493. Article Review
Title: Quirce S et al; "Prevalence of Uncontrolled Severe Persistent Asthma in Pneumology and Allergy Hospital Units in Spain." Journal of Investigational Allergology and Clinical Immunology; V.21; 2011; p466
      PREVALENCE (EUROPE): The International Study of Asthma and Allergies in Childhood (ISAAC) has shown that asthma prevalence is similar across Western European Mediterranean countries (8.9% to 13.5%), with the exception of Greece, which has one of the lowest prevalence rates (3.7%). According to a phase-III ISAAC study conducted in 2002 and 2003, the prevalence of asthma in Spanish children aged 6 to 7 years is 10.7% for boys and 8.2% for girls; in children aged 13 to 14 years, the respective rates are 9.3% and 9.2%. Data are scarce regarding the prevalence of asthma in adults, and rates vary greatly from one geographical area to the next. It is, however, widely accepted that approximately 5% of the Spanish adult population have asthma.
      BURDEN OF UNCONTROLLED ASTHMA: Direct and indirect medical costs associated with asthma are very high, and moreover 1 in every 250 deaths worldwide is asthma related. While just a small group of patients have uncontrolled severe persistent asthma, they use a disproportionate amount of health care resources (over 50% of asthma-related health care resources). It has been estimated that the cost of a patient with severe asthma in Spain is almost 6 times that of a patient with moderate asthma.
      STUDY DESIGN: The main objective of this study was to determine the prevalence of severe uncontrolled asthma in asthma patients seen at pneumology and allergology hospital units in Spain. Of 201 specialists approached, 164 agreed to recruit patients. 36,649 asthmatic patients were screened by the 164 participating hospitals during the 6 months of the study.
      SEVERE UNCONTROLLED ASTHMA: 1131 patients with uncontrolled severe persistent asthma or moderate to severe asthma were recruited. The prevalence of uncontrolled severe persistent asthma diagnosed by clinicians was 3.9%. Exclusions left 1011 patients (89.4%). According to the Global Initiative for Asthma (GINA) guidelines, 666 patients (65.9%) had uncontrolled severe persistent asthma, and 345 (34.1%) had moderate to severe controlled asthma.
      SENSITIZATION: Of the 861 patients with positive skin-prick tests, 467 (54.2%) were sensitized to at least 1 aeroallergen; 52.9% were sensitized to mites, 44.8% to pollen, 29.6% to animal epithelia, and 12% to fungi (Alternaria or Aspergillus). No statistical differences were observed between patients with moderate to severe asthma and those with uncontrolled severe persistent asthma.
      RISK FACTORS: The risk factors significantly associated with uncontrolled severe persistent asthma were female sex (odds ratio/OR, 1.5), and high body mass index (BMI) (OR 1.0).
      TREATMENT: The most common pharmacological treatments overall were inhaled corticosteroids (97.5%), long-acting beta-agonists (90.0%), and leukotriene receptor antagonists (LTRAs) (44.3%). Patients with uncontrolled severe persistent asthma had a significantly higher use of the following treatments compared to patients with moderate to severe asthma: LTRAs (49.5% vs 34.0%), short-acting beta-agonists (45.1% vs 35.2%), oral corticosteroids (28.5% vs 4.5%), anticholinergics (20.8% vs 9.3%), and xanthines (9.6% vs 1.8%). It should be noted that patients may have been receiving more than 1 treatment.
      DISCUSSION: The results show a low prevalence of uncontrolled severe persistent asthma (3.9%). The Asthma Insights and Reality in Europe (AIRE) study showed that just 5.3% of all patients in European countries met all the GINA criteria for asthma control, while a study conducted by the ESCASE Group in Spain showed a high number of patients with inadequate asthma control, with slightly higher figures in winter than in spring (74.4% vs 71%). Another study conducted in Spain reported a similar rate of uncontrolled asthma (71.6%). These studies, however, included patients with mild and moderate disease. Furthermore, they defined uncontrolled asthma according to GINA guidelines, in combination with the Asthma Control Questionnaire or the Asthma Control Test, contrasting with the present study, in which level of control was determined according to clinical criteria. The present survey shows that uncontrolled asthma is largely underdiagnosed by clinicians.

Search Criteria: Text - Journal of Investigational Allergology and Clinical Immunology; V.21; 2011; p466