Reality and understanding of asthma control

Area of Science:

• Pulmonology
• Public Health
• Clinical Medicine

Background:

• Revised asthma management guidelines were introduced in Trinidad.
• Severe asthma control and patient perception of control require evaluation post-guideline implementation.

Purpose of the Study:

• To assess the level and perception of asthma control in severe asthma patients in Trinidad.
• To examine the concordance between measured and perceived asthma control.
• To identify factors associated with uncontrolled asthma.

Main Methods:

• Cross-sectional study of 329 adult asthma patients at Trinidad chest clinics.
• Assessment of guideline-defined disease control, including measured and perceived control.
• Analysis of co-morbidities, lung function (peak expiratory flow), and asthma-related symptoms and healthcare utilization.

Main Results:

• Poor concordance (κ=0.197) between measured (45.29%) and perceived (18.96%) uncontrolled asthma.
• Co-morbidity (≥2 conditions) was linked to uncontrolled asthma (p=0.03).
• High prevalence of asthma burden: hospitalization (53.80%), emergency visits (66.36%), and symptoms like dyspnea (84.50%) and cough (74.49%).
• Low rates of self-monitoring (lung function: 9.73%, diary: 6.69%) and a belief that patients must live with symptoms (65.1%).

Conclusions:

• Severe asthma control and associated morbidity remain suboptimal in Trinidad post-guideline revision.
• A significant discrepancy exists between objective measures of asthma control and patients' subjective perception.
• Enhanced strategies are needed to translate asthma management guidelines into effective patient care, addressing the gap in perceived control.