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Asthma/COPD clinics increases adherence to management guidelines and associates with less morbidity and lower
Jenny Nilsson1, Helena Backman2, Johanna Karlsson Sundbaum2
1Department of public health and clinical medicine, The OLIN and Sunderby Research Unit, Umeå University, Umeå, Sweden. jenny.b.nilsson@norrbotten.se.
Insights
Certified asthma/COPD clinics (ACCs) improve guideline adherence and asthma control. These specialized clinics are linked to better patient outcomes, including reduced healthcare use and mortality, compared to regular care.
Area of Science:
- Pulmonary Medicine
- Clinical Epidemiology
- Healthcare Management
Background:
- Suboptimal asthma control is prevalent, often stemming from limited self-management knowledge, undertreatment, and infrequent follow-ups.
- Asthma/COPD Clinics (ACCs) are recommended in Swedish primary care, but evidence on their effectiveness is scarce.
- Current primary care models may not fully address the complexities of asthma management.
Purpose of the Study:
- To compare certified ACCs with regular care clinics regarding adherence to asthma management guidelines.
- To investigate the association between ACC care and asthma symptom control, healthcare consumption, and mortality in adults with asthma.
- To evaluate the impact of guideline adherence on patient outcomes in asthma management.
Main Methods:
- A cohort study utilizing data from the Swedish National Airway Register (n=84,230 adults with asthma).
- Comparison between patients at certified ACCs (17 centers) and regular care clinics (650 centers) from 2015-2017, with follow-up until 2022.
- Data linkage with national registers for pharmaceuticals, healthcare consumption, and mortality; binary logistic regression for outcome assessment.
Main Results:
- Patients at certified ACCs received more guideline-adherent interventions (e.g., patient education, action plans, spirometry, ICS).
- Certified ACCs were associated with lower odds of uncontrolled asthma (OR 0.76), reduced need for specialist/emergency care (OR 0.69), and decreased mortality (OR 0.69).
- No significant association was found between ACCs and reduced frequency of asthma exacerbations.
Conclusions:
- Certified ACCs demonstrate superior adherence to asthma management guidelines compared to regular care.
- ACCs are associated with improved asthma control, decreased healthcare utilization, and lower all-cause mortality.
- The findings underscore the value of specialized ACCs in delivering evidence-based, guideline-adherent asthma care.
Abstract:
In asthma, suboptimal disease control is common due to limited knowledge about self-management, undertreatment and infrequent follow-up visits. Most patients are treated in primary care where asthma/COPD clinics (ACC) are recommended in Sweden, but evidence of the effects is limited. The aim was to compare certified ACCs with clinics providing regular care in terms of adherence to asthma management guidelines, and the associations with asthma symptom control, healthcare consumption, and mortality in adults with asthma. In this cohort study, we extracted data from the Swedish National Airway Register, on 84230 adults with asthma, cared for at certified ACCs (n = 17 primary care centres) and regular care clinics (n = 650 primary care centres) in Sweden. Data were linked to other national registers in order to obtain data about pharmaceuticals, healthcare consumption, and mortality. The index date was the years 2015-2017, and the study ended in 2022. A binary logistic regression was used to assess morbidity and mortality associations at the study's end. A higher proportion of patients at certified ACCs received interventions such as patient education, written asthma action plan, smoking cessation, Asthma Control Test, spirometry, and inhaled corticosteroids than patients at regular care clinics. Certified ACCs were associated with a lower probability of uncontrolled asthma (OR 0.76, 95% CI 0.67-0.87), need of specialist/emergency care (OR 0.69, 95% CI 0.51-0.92) and death (OR 0.69, 95% CI 0.55-0.86). In conclusion, adherence to asthma management guidelines was higher in certified ACCs which were associated with a more well-controlled asthma, less secondary healthcare visits and lower all-cause mortality, but not with frequent exacerbations. Our findings highlight the importance of ACCs in providing evidence-based care in accordance with asthma management guidelines.
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