Assessment of asthma control in primary care

Abstract Objective: To determine the prevalence of uncontrolled asthma in patients who are visiting their primary care provider for any reason. Research design and methods: This multisite, cross-sectional survey was conducted between January 25 and May 2, 2008. Participants aged ≥18 years were recruited from 35 primary care provider sites. Eligible participants presented to the office for any acute medical, routine, follow-up, or nonmedical reason; had a self-reported physician diagnosis of asthma; used medication to treat asthma in the past year; and had no history of COPD. They completed the Asthma Control Test (ACT) and provided information including demographics, health behaviors, medical history, and asthma medication use. Uncontrolled asthma was defined as ACT score ≤19. † Asthma Control Test is a trademark of QualityMetric, Inc., Lincoln, RI, USA. Results: The overall weighted prevalence of uncontrolled asthma in 2238 patients in primary care was 58% (95% confidence interval [CI], 0.56–0.60). Among asthma patients seeking care for a respiratory complaint, 72% (95% CI, 0.68–0.75) had uncontrolled asthma compared to 48% (95% CI, 0.45–0.51) of asthma patients presenting for a non-respiratory reason. Conclusions: At the population level, over half of patients with asthma under primary care management had uncontrolled asthma at the time of an office visit. Surprisingly, nearly 50% of patients with asthma who presented for office visits not associated with respiratory-related complaints had uncontrolled asthma. The study results may be influenced by a seasonal effect of upper respiratory infections and by the insurance status of the study respondents. However identifying patients with uncontrolled asthma is important and remains a challenge. Therefore, health care providers should consider evaluating asthma control on a regular basis, regardless of reason for visit.