Tracing Uncontrolled Asthma in Family Practice Using a Mailed Asthma Control Questionnaire

Abstract

PURPOSE A substantial proportion of adult patients with asthma have inadequately controlled symptoms despite the availability of effective treatment. The Asthma Control Questionnaire (ACQ) can be used to discriminate between asthma patients with well-and suboptimally controlled asthma symptoms. The objective of this study was to investigate whether a postal mailing of the ACQ can be used to identify asthma patients with suboptimal symptom control in family practice. METHODSIn this observational study, we sent 434 asthma patients from 6 Dutch family practices an ACQ by mail to measure control of their asthma symptoms. Both respondents and nonrespondents were characterized by information gathered from their medical records. Patients with an ACQ sum score (total score) of greater than 3 were considered to have suboptimally controlled asthma symptoms. RESULTSThe response rate was 77%. Respondents were more likely than nonrespondents to be female and to use asthma medication. The mean ACQ sum score of the respondents was 5.2. Of this group, 53.4% (95% confi dence interval, 48.0%-58.8%) had suboptimally controlled asthma symptoms. Of the 168 respondents who had not visited their family physician in the 2 years before the study, 42.9% (95% confi dence interval, 35.4%-50.4%) had inadequate asthma symptom control. CONCLUSIONSOur results show that a postal mailing of the ACQ is an effective approach for tracing asthma patients who need medical attention. It also traces patients who would otherwise not have consulted their family physician. The ACQ seems to be a useful starting point for health care professionals in family practice to improve the level of asthma symptom control in their patient population.Ann Fam Med 2008;6(suppl 1):s16-s22. DOI: 10.1370/afm.776. INTRODUCTIONP opulation surveys have shown that despite the availability of highly effective pharmacotherapy, the majority (up to 70%-95%) of all asthma patients in western Europe and the Asia-Pacifi c region have signs of poor asthma control.1-3 Known causes of this suboptimal level of asthma control are poor adherence to periodic management visits to health care professionals [4][5][6] or insuffi cient compliance with prescribed asthma medication, especially inhaled corticosteroids. 5 In addition, patients with asthma-and their physicians-tend to overestimate their level of asthma control. 7,8 These factors emphasize the need to improve the identifi cation of poor asthma control and subsequent treatment. Because the majority of patients with asthma are treated by family physicians, family practice would be the most appropriate setting to study the tracing of patients with poor asthma control.Bronchial infl ammation is a marker of asthma control that can be assessed by induced sputum eosinophilia 9 or bronchial hyperrespon- S17T R ACING UNCONT ROL L ED A S T HM A siveness. 10 The requirement of laboratory facilities, the time-consuming nature of these tests, and their unfriendliness to patients severely hamper their routine use in primary care, however. ...

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