Asthma control in the Portuguese National Asthma Survey
A.. Sá-Sousaa, R.. Amarala, M.. Morais-Almeidab,c, L.. Araújod,e,f, L.F.. Azevedoa,e, A.. Bugalho-Almeidab,g, J.. Bousqueth,i, J.A.. Fonsecaa,
,c,e,f
a Center for Research in Health Technologies and Information Systems – CINTESIS, Universidade do Porto, Porto, Portugal
b Allergy and Clinical Immunology Department, Hospital CUF-Descobertas, Lisboa, Portugal
c Sociedade Portuguesa de Alergologia e Imunologia Clínica, Lisbon, Portugal
d Immunology Department, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
e Health Information and Decision Sciences Department – CIDES, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
f Allergy Unit, Instituto CUF Porto e Hospital CUF Porto, Porto, Portugal
g Comissão de Acompanhamento do Programa Nacional de Controlo da Asma, Lisbon, Portugal
h Hôpital Arnaud de Villeneuve, Centre Hospitalier Universitaire Montpellier, Montpellier, France
i Centre de recherche en Epidémiologie et Santé des Populations – CESP Inserm U1018, Villejuif, France
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In A the horizontal line represents the Mini-AQLQ cut-off of 5.4 based on previous study; <span class="elsevierStyleSup">11</span> NCA: non-controlled asthma; CA: Controlled asthma. In (B, C and D) the vertical lines represent the Mini-AQLQ cut-off of 5.4 <span class="elsevierStyleSup">11</span> and the horizontal lines represent the CARAT cut-offs; <span class="elsevierStyleSup">9</span> (B) global score cut-off of 24; (C) superior airways subscore cut-off of 8 and (D) the CARAT inferior subscore cut-off of 16. The scatterplots are divided into four quadrants, the inferior left corresponds to participants with non-controlled disease and more impairments and the upper right to participants with controlled disease and less impairments." ] ] ] "textoCompleto" => "<a name="sec0005" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Introduction</span><p class="elsevierStylePara">Proper asthma therapy and education reduces the socioeconomic burden of asthma and improves patients’ quality of life.<a href="#bib15" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">1</span></a> However, the proportion of patients achieving asthma control remains low worldwide without substantial improvement in recent years.<a href="#bib16" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">2</span></a><span class="elsevierStyleSup">, </span><a href="#bib17" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">3</span></a><span class="elsevierStyleSup">, </span><a href="#bib18" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">4</span></a><span class="elsevierStyleSup">, </span><a href="#bib19" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">5</span></a><span class="elsevierStyleSup">, </span><a href="#bib20" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">6</span></a></p><p class="elsevierStylePara">The Portuguese National Program for Asthma Control conducted by the Directorate-General of Health between 2005 and 2010, aimed to increase the proportion of asthma patients with controlled disease, and to decrease the personal and community burden of the disease.</p><p class="elsevierStylePara">At the end of this program, in 2010, we conducted the first Portuguese National Asthma Survey – <span class="elsevierStyleItalic">Inquérito Nacional sobre Asma</span> (INAsma), which consisted of two phases. In the first phase, aiming to evaluate asthma prevalence, we estimated that 7% of the Portuguese population had current asthma.<a href="#bib21" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">7</span></a> In the second phase we focused on asthma patients addressing disease control.</p><p class="elsevierStylePara">We aim to measure asthma control using a structure-questionnaire and patient self-perception of asthma-control in the Portuguese National Asthma Survey (INAsma) and to study the relation of asthma control with asthma-related quality of life (ARQoL).</p><a name="sec0010" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Methods</span><p class="elsevierStylePara">The INAsma was a cross-sectional, nationwide, telephone interview study. Sample size calculations details have been previously reported.<a href="#bib21" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">7</span></a> All the participants identified with possible asthma in the first phase of the survey were eligible for participation in the second phase. Detailed information is provided in the Supplementary Material. The study was approved by the Hospital Ethics Committee of <span class="elsevierStyleItalic">Hospital de São João (Porto, Portugal)</span>.</p><p class="elsevierStylePara">Current asthma was defined as self-report of asthma and one of the following: at least one medical appointment due to asthma in the last 12 months; current use of asthma medication; asthma symptoms in the last 12 months (wheeze, cough, breathlessness or sputum production without a cold or respiratory infection).</p><p class="elsevierStylePara">Asthma control was defined based on Control of Allergic Rhinitis and Asthma Test (CARAT) scores.<a href="#bib22" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">8</span></a><span class="elsevierStyleSup">, </span><a href="#bib23" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">9</span></a> Asthma was considered controlled for CARAT global score above 24 or CARAT lower airways score of 16 or above. Self-perception of asthma control was evaluated by the answer to the question “Do you believe your asthma was well controlled in the last 4 weeks?”. Additional questions were included assessing socio-educational variables.</p><p class="elsevierStylePara">ARQoL was measured by mini-Asthma Quality of Life Questionnaire (mini-AQLQ)<a href="#bib24" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">10</span></a> with a cut-off value of 5.4 set according to a previous study in northern Portugal.<a href="#bib25" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">11</span></a></p><p class="elsevierStylePara">Statistical analyses were performed using IBM SPSS Statistics v21 (2012 SPSS Inc., IBM Company, Chicago, US). Categorical variables were described with absolute frequencies, proportions and 95% Confidence Interval (95% CI) and continuous variables were described with measures of central tendency and dispersion as appropriate. Correlation between CARAT and mini-AQLQ scores was tested with Pearson's Correlation Coefficient, with a <span class="elsevierStyleItalic">p</span>-value of <0.05 considered as statistically significant.</p><a name="sec0015" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Results</span><p class="elsevierStylePara">Of the 707 participants identified with possible asthma in the Phase 1, 559 agreed to participate in Phase 2, from which 405 had current asthma as described in the online supplement (Fig. S1). Sufficient data to define asthma control were available for 364 patients. Participants’ characteristics are summarized in <a href="#t0005" class="elsevierStyleCrossRefs">Table 1</a>.</p><p class="elsevierStylePara">Table 1. Socio-demographic characteristics of the participants with classification for asthma control by asthma control status and patient perception of control and asthma related quality of life.</p><a name="t0005" class="elsevierStyleCrossRefs"></a><p class="elsevierStylePara"></p><table><tr align="left"><td> </td><td>Total (<span class="elsevierStyleItalic">n</span> = 364)</td><td colspan="2">Controlled asthma</td><td colspan="2">Patient perception of control</td><td colspan="2">ARQoL cut-off value</td></tr><tr align="left"><td> </td><td> </td><td>Yes (<span class="elsevierStyleItalic">n</span> = 207)</td><td>No (<span class="elsevierStyleItalic">n</span> = 157)</td><td>Controlled (<span class="elsevierStyleItalic">n</span> = 338)</td><td>Non-controlled (<span class="elsevierStyleItalic">n</span> = 21)</td><td>Above (<span class="elsevierStyleItalic">n</span> = 188)</td><td>Below (<span class="elsevierStyleItalic">n</span> = 89)</td></tr><tr align="left"><td colspan="8"><span class="elsevierStyleItalic">Sex, n (%)</span></td></tr><tr align="left"><td>Male</td><td>155 (42.6)</td><td>111 (71.6)</td><td>44 (28.4)</td><td>146 (96.1)</td><td>6 (3.9)</td><td>79 (81.4)</td><td>18 (18.6)</td></tr><tr align="left"><td>Female</td><td>209 (57.4)</td><td>96 (45.9)</td><td>113 (54.1)</td><td>192 (92.8)</td><td>15 (7.2)</td><td>109 (60.6)</td><td>71 (39.4)</td></tr><tr align="left"><td colspan="8"> </td></tr><tr align="left"><td colspan="8"><span class="elsevierStyleItalic">Age groups, n (%)</span></td></tr><tr align="left"><td><18 years old</td><td>87 (23.9)</td><td>59 (67.8)</td><td>28 (32.2)</td><td>82 (96.0)</td><td>4 (4.7)</td><td>0 (0.0)</td><td>0 (0.0)</td></tr><tr align="left"><td>18–64 years old</td><td>177 (48.6)</td><td>112 (63.3)</td><td>65 (36.7)</td><td>168 (96.0)</td><td>7 (4.0)</td><td>132 (74.6)</td><td>45 (25.4)</td></tr><tr align="left"><td>>64 years old</td><td>100 (27.5)</td><td>36 (6.0)</td><td>64 (64.0)</td><td>88 (89.8)</td><td>10 (10.2)</td><td>56 (56.0)</td><td>44 (44.0)</td></tr><tr align="left"><td colspan="8"> </td></tr><tr align="left"><td colspan="8"><span class="elsevierStyleItalic">Education level</span><span class="elsevierStyleSup">a</span> , <span class="elsevierStyleItalic">n (%)</span></td></tr><tr align="left"><td><9 years</td><td>240 (65.9)</td><td>120 (50.0)</td><td>120 (50.0)</td><td>220 (92.4)</td><td>18 (7.6)</td><td>92 (57.5)</td><td>68 (42.5)</td></tr><tr align="left"><td>9–12 years</td><td>83 (22.8)</td><td>57 (68.7)</td><td>26 (31.3)</td><td>80 (98.8)</td><td>1 (1.2)</td><td>60 (78.9)</td><td>16 (21.1)</td></tr><tr align="left"><td>>12 years</td><td>41 (11.3)</td><td>30 (73.2)</td><td>11 (26.8)</td><td>38 (95.0)</td><td>2 (5.0)</td><td>36 (87.8)</td><td>5 (12.2)</td></tr><tr align="left"><td colspan="8"> </td></tr><tr align="left"><td colspan="8"><span class="elsevierStyleItalic">SES</span><span class="elsevierStyleSup">b</span> , <span class="elsevierStyleItalic">n (%)</span></td></tr><tr align="left"><td>Low</td><td>59 (16.3)</td><td>18 (30.5)</td><td>41 (69.5)</td><td>51 (87.9)</td><td>7 (5.9)</td><td>29 (49.2)</td><td>30 (50.8)</td></tr><tr align="left"><td>Medium low</td><td>222 (61.2)</td><td>127 (57.2)</td><td>95 (42.8)</td><td>211 (95.9)</td><td>9 (4.1)</td><td>116 (69.5)</td><td>51 (30.5)</td></tr><tr align="left"><td>Medium high</td><td>49 (13.5)</td><td>35 (71.4)</td><td>14 (28.6)</td><td>44 (91.7)</td><td>4 (8.3)</td><td>27 (84.8)</td><td>5 (15.6)</td></tr><tr align="left"><td>High</td><td>33 (9.1)</td><td>27 (81.8)</td><td>6 (18.2)</td><td>31 (96.9)</td><td>1 (3.1)</td><td>15 (83.3)</td><td>3 (16.7)</td></tr><tr align="left"><td colspan="8"> </td></tr><tr align="left"><td colspan="8"><span class="elsevierStyleItalic">Smoking status, n (%)</span></td></tr><tr align="left"><td>Non-smoker</td><td>274 (75.3)</td><td>153 (55.8)</td><td>121 (44.2)</td><td>255 (93.8)</td><td>17 (6.3)</td><td>121 (64.0)</td><td>68 (36.0)</td></tr><tr align="left"><td>Ex-smoker</td><td>53 (14.6)</td><td>33 (62.3)</td><td>20 (37.7)</td><td>46 (92.0)</td><td>4 (8.0)</td><td>39 (73.6)</td><td>14 (26.4)</td></tr><tr align="left"><td>Current smoker</td><td>37 (10.2)</td><td>21 (56.8)</td><td>16 (43.2)</td><td>37 (100.0)</td><td>0 (0.0)</td><td>28 (80.0)</td><td>7 (20.0)</td></tr><tr align="left"><td colspan="8"> </td></tr><tr align="left"><td colspan="8"><span class="elsevierStyleItalic">Controlled asthma, n (%)</span></td></tr><tr align="left"><td>Yes</td><td>207 (56.9)</td><td>–</td><td>–</td><td>201 (98.5)</td><td>3 (1.5)</td><td>137 (92.6)</td><td>11 (7.4)</td></tr><tr align="left"><td>No</td><td>157 (43.1)</td><td>–</td><td>–</td><td>137 (88.4)</td><td>18 (85.7)</td><td>51 (39.5)</td><td>78 (60.5)</td></tr><tr align="left"><td colspan="8"> </td></tr><tr align="left"><td colspan="8"><span class="elsevierStyleItalic">Patient perception of control, n (%)</span></td></tr><tr align="left"><td>Controlled</td><td>338 (94.2)</td><td>201 (59.5)</td><td>137 (40.5)</td><td>–</td><td>–</td><td>181 (70.7)</td><td>75 (29.3)</td></tr><tr align="left"><td>Not controlled</td><td>21 (5.8)</td><td>3 (14.3)</td><td>18 (85.7)</td><td>–</td><td>–</td><td>3 (17.6)</td><td>14 (82.4)</td></tr></table><p class="elsevierStylePara">Asthma Related Quality of Life (ARQoL) cut-off value of 5.4.<br></br></p><p class="elsevierStylePara">a A total of 60 (2.7%) participants were preschoolers (not shown) – Data retrieved from 1st phase of INAsma.<br></br>b Socioeconomic Status was categorized in high (A social class), medium high (B social class), medium low (C social classes) and low (D social class) based on occupation and school education of the person who contributes more for the household income – Data retrieved from 1st phase of INAsma.<br></br></p><p class="elsevierStylePara">According to the patients’ answers to CARAT, the most frequent symptoms were related to upper airways with 24.9% (<span class="elsevierStyleItalic">n</span> = 90) and 21.4% (<span class="elsevierStyleItalic">n</span> = 78) of the patients answering “Always”, to sneezing and itchy nose, respectively (Fig. S2). The less common symptom reported was nocturnal awakening with 69.5% (<span class="elsevierStyleItalic">n</span> = 253) of the patients answering “Never”.</p><p class="elsevierStylePara">Asthma was controlled in 56.9% [95%CI, 51.8–62.0] (<span class="elsevierStyleItalic">n</span> = 207) of the patients (<a href="#t0005" class="elsevierStyleCrossRefs">Table 1</a>). Regarding patient self-perception of control, 94% (<span class="elsevierStyleItalic">n</span> = 338) reported having their asthma controlled (<a href="#t0005" class="elsevierStyleCrossRefs">Table 1</a>). Among the non-controlled patients 88.4% (<span class="elsevierStyleItalic">n</span> = 137) perceived their asthma as controlled (<a href="#t0005" class="elsevierStyleCrossRefs">Table 1</a>, Fig. S3).</p><p class="elsevierStylePara">Controlled patients had higher mini-AQLQ scores than the non-controlled (median, P25–P75; 6.6, 6.0–6.9 and 4.9, 3.7–5.7, respectively; <span class="elsevierStyleItalic">p</span> < 0.001) (<a href="#f0020" class="elsevierStyleCrossRefs">Figure 1</a>A). A significant positive correlation between CARAT and mini-AQLQ scores was observed (<span class="elsevierStyleItalic">r</span> = 0.706; <span class="elsevierStyleItalic">p</span> < 0.001, <a href="#f0020" class="elsevierStyleCrossRefs">Figure 1</a>B).</p><a name="f0020" class="elsevierStyleCrossRefs"></a><p class="elsevierStylePara"><img src="320v21n04-90433950fig1.jpg" alt="Relationship between CARAT and mini-AQLQ scores (<i>n</i> = 274); (A) ARQoL by asthma control groups; Scatterplots show the correlation between (B) CARAT global score and ARQoL; (C) CARAT superior airways subscore and ARQoL; (D) CARAT inferior airways subscore and ARQoL. In A the horizontal line represents the Mini-AQLQ cut-off of 5.4 based on previous study;<cross-ref><sup>11</sup></cross-ref> NCA: non-controlled asthma; CA: Controlled asthma. In (B, C and D) the vertical lines represent the Mini-AQLQ cut-off of 5.4<cross-ref><sup>11</sup></cross-ref> and the horizontal lines represent the CARAT cut-offs;<cross-ref><sup>9</sup></cross-ref> (B) global score cut-off of 24; (C) superior airways subscore cut-off of 8 and (D) the CARAT inferior subscore cut-off of 16. The scatterplots are divided into four quadrants, the inferior left corresponds to participants with non-controlled disease and more impairments and the upper right to participants with controlled disease and less impairments."></img></p><p class="elsevierStylePara">Figure 1. Relationship between CARAT and mini-AQLQ scores (<span class="elsevierStyleItalic">n</span> = 274); (A) ARQoL by asthma control groups; Scatterplots show the correlation between (B) CARAT global score and ARQoL; (C) CARAT superior airways subscore and ARQoL; (D) CARAT inferior airways subscore and ARQoL. In A the horizontal line represents the Mini-AQLQ cut-off of 5.4 based on previous study; <span class="elsevierStyleSup">11</span> NCA: non-controlled asthma; CA: Controlled asthma. In (B, C and D) the vertical lines represent the Mini-AQLQ cut-off of 5.4 <span class="elsevierStyleSup">11</span> and the horizontal lines represent the CARAT cut-offs; <span class="elsevierStyleSup">9</span> (B) global score cut-off of 24; (C) superior airways subscore cut-off of 8 and (D) the CARAT inferior subscore cut-off of 16. The scatterplots are divided into four quadrants, the inferior left corresponds to participants with non-controlled disease and more impairments and the upper right to participants with controlled disease and less impairments.</p><a name="sec0020" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Discussion</span><p class="elsevierStylePara">We report the first nationwide results on asthma control in Portugal with more than half (57%) of the patients presenting controlled asthma. A significant positive correlation was found between CARAT and mini-AQLQ, indicating that patients with controlled asthma had significant better ARQoL comparing to patients with non-controlled asthma. However, most patients (88%) with non-controlled asthma perceived their asthma as controlled.</p><p class="elsevierStylePara">The proportion of asthma control was in accordance with recent studies in other countries.<a href="#bib18" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">4</span></a> In 2010, the European National Health and Wellness Survey<a href="#bib19" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">5</span></a> estimated a global proportion of non-controlled asthma of 53.5% across five European countries. Similarly, the International Asthma Patient Insight Research (INSPIRE) study<a href="#bib18" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">4</span></a> found a worldwide proportion of non-controlled asthma of 51%. In Portugal, a study of asthma patients from one Allergy unit concluded that 57% had partially or complete asthma control when assessed with ACT.<a href="#bib26" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">12</span></a></p><p class="elsevierStylePara">A strong positive correlation was observed between asthma control assessed by CARAT and ARQoL assessed by Mini-AQLQ. This correlation was similar to previous reports using other asthma control questionnaires<a href="#bib25" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">11</span></a><span class="elsevierStyleSup">, </span><a href="#bib27" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">13</span></a><span class="elsevierStyleSup">, </span><a href="#bib28" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">14</span></a> but had not been reported with CARAT questionnaire.</p><p class="elsevierStylePara">Most of the participants with non-controlled asthma perceived their disease as controlled. This is very similar to the data from the Asthma Insights and Reality in Europe survey.<a href="#bib17" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">3</span></a> Also in the INSPIRE study,<a href="#bib18" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">4</span></a> patient perception of asthma control was strikingly different from that based on symptoms assessment. These data suggest that patients, especially those with poor control, continue to have very low expectations regarding asthma outcomes. Clinical studies are warranted on the relation between asthma control and patient-self perception of control.</p><p class="elsevierStylePara">The main strength of the present study is that INAsma is the first Portuguese study to include patients from the general population from all municipalities and all age groups.<a href="#bib21" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">7</span></a> Some limitations are inherent to a landline telephone-based interview study, especially with the recent shift from landline telephones to cellphones. Other limitation is the potential for confusion as the definition of control may have been influenced by the rhinitis subscore. However, we compared the results of patients with and without associated rhinitis and there were no differences in the proportion of patients with controlled asthma, in perceptions of asthma control and in the correlation between asthma control and ARQoL (data not shown). Moreover, the CARAT superior airways subscore seems not to have affected the correlation between CARAT total score and miniARQLQ (<a href="#f0020" class="elsevierStyleCrossRefs">Figure 1</a>C).</p><p class="elsevierStylePara">In conclusion, more than half of the Portuguese asthma patients have their disease controlled and these have significantly better asthma-related quality of life. Poor perception of control seems to be an obstacle to achieving better disease control as almost 9 out of 10 patients with non-controlled disease had poor perception of their asthma control. The objective assessment of asthma control using validated tools may help patients to increase their expectations regarding asthma outcomes.</p><a name="sec0025" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Ethical disclosures</span><a name="sec0030" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Protection of human and animal subjects</span><p class="elsevierStylePara">The authors declare that no experiments were performed on humans or animals for this study.</p><a name="sec0035" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Confidentiality of data</span><p class="elsevierStylePara">The authors declare that no patient data appear in this article.</p><a name="sec0040" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Right to privacy and informed consent</span><p class="elsevierStylePara">The authors declare that no patient data appear in this article.</p><a name="sec0045" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Conflicts of interest</span><p class="elsevierStylePara">The authors have no conflicts of interest to declare.</p><p class="elsevierStylePara">Acknowledgements</p><p class="elsevierStylePara">The Portuguese National Asthma Survey – <span class="elsevierStyleItalic">Inquérito Nacional sobre Asma</span> (INAsma) was conducted by the Center for Health Technology and Services Research (CINTESIS) in collaboration with <span class="elsevierStyleItalic">Sociedade Portuguesa de Pneumologia</span>, by appointment of the Portuguese Health Directorate.</p><p class="elsevierStylePara">The work presented in this short communication was partially funded by FEDER funds through COMPETE (<span class="elsevierStyleItalic">Programa Operacional Factores de Competitividade</span>) and by National funds through a FCT (<span class="elsevierStyleItalic">Fundação para a Ciência e a Tecnologia</span>) project with reference “PTDC/SAU-SAP/119192/2010”.</p><a name="sec0050" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Appendix A. Supplementary data</span><p class="elsevierStylePara">Supplementary material associated with this article can be found in the online version available at <a href="http://doi.org/10.1016/j.rppneu.2014.08.001" class="elsevierStyleCrossRefs">http://doi.org/10.1016/j.rppneu.2014.08.001</a>.</p><a name="sec0055" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Appendix A. Supplementary data</span><p class="elsevierStylePara"><a name="f0005" class="elsevierStyleCrossRefs"></a></p><p class="elsevierStylePara"><img src="320v21n04-90433950fig1.jpg" alt="Participants Flowchart. From 559 participants 405 had current asthma and 207 had their asthma controlled."></img></p><p class="elsevierStylePara">Supplementary Fig. S1. Participants Flowchart. From 559 participants 405 had current asthma and 207 had their asthma controlled.</p><a name="f0010" class="elsevierStyleCrossRefs"></a><p class="elsevierStylePara"><img src="320v21n04-90433950fig2.jpg" alt="Answers to CARAT questionnaire. Questions 1–9: dark blue “Never”; yellow “Up to 2 days per week”; orange “More than 2 days per week”; red “Almost every day or every day”. Question 10: light blue “Not taking medication”; dark blue “Never”; orange “Less than 7 days”; red “7 or more days”."></img></p><p class="elsevierStylePara">Supplementary Fig. S2. Answers to CARAT questionnaire. Questions 1–9: dark blue “Never”; yellow “Up to 2 days per week”; orange “More than 2 days per week”; red “Almost every day or every day”. Question 10: light blue “Not taking medication”; dark blue “Never”; orange “Less than 7 days”; red “7 or more days”.</p><a name="f0015" class="elsevierStyleCrossRefs"></a><p class="elsevierStylePara"><img src="320v21n04-90433950fig3.jpg" alt="Perceived asthma control by asthma control status. From the 359 participants who answered to the question “Did you feel that your asthma was well controlled?”, 155 had non-controlled asthma and 204 had their asthma controlled, based on CARAT scores."></img></p><p class="elsevierStylePara">Supplementary Fig. S3. Perceived asthma control by asthma control status. From the 359 participants who answered to the question “Did you feel that your asthma was well controlled?”, 155 had non-controlled asthma and 204 had their asthma controlled, based on CARAT scores.</p><p class="elsevierStylePara"><elsevierMultimedia href="320v21n04-90433950mmc4.pdf"></elsevierMultimedia></p><p class="elsevierStylePara">Received 2 May 2014 <br></br>Accepted 19 August 2014 </p><p class="elsevierStylePara">Corresponding author. jfonseca@med.up.pt</p>" "pdfFichero" => "320v21n04a90433950pdf001.pdf" "tienePdf" => true "PalabrasClave" => array:1 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec640981" "palabras" => array:5 [ 0 => "Asthma" 1 => "Disease management" 2 => "Cross-sectional studies" 3 => "Quality of life" 4 => "Control perception" ] ] ] ] "tieneResumen" => true "resumen" => array:1 [ "en" => array:1 [ "resumen" => "<span class="elsevierStyleSectionTitle">Introduction</span><br/><p class="elsevierStylePara">We aimed (1) to measure asthma control using a structure-questionnaire and patient self-perception of asthma-control in the Portuguese National Asthma Survey (INAsma) and (2) to study the relationship between asthma control and asthma-related quality of life.</p><span class="elsevierStyleSectionTitle">Methods</span><br/><p class="elsevierStylePara">We analyze data of asthma patients from a cross-sectional, nationwide telephone interview study – INAsma. Controlled asthma was defined as CARAT global score >24 or CARAT lower airways score ≥16. Mini-AQLQ was used to measure quality of life.</p><span class="elsevierStyleSectionTitle">Results</span><br/><p class="elsevierStylePara">Two hundred and seven (56.9% [95%CI: 51.8–62.0]) of the 364 patients had controlled asthma. Most patients with non-controlled asthma (88%) perceived their disease as controlled. Patients with controlled asthma presented higher mini-AQLQ scores (median, P25–P75; 6.6, 6.0–6.9) than those with non-controlled asthma (4.9, 3.7–5.7) (<span class="elsevierStyleItalic">p</span> < 0.001) and a significant positive correlation between CARAT and mini-AQLQ scores was observed (<span class="elsevierStyleItalic">r</span> = 0.706; <span class="elsevierStyleItalic">p</span> < 0.001).</p><span class="elsevierStyleSectionTitle">Conclusion</span><br/><p class="elsevierStylePara">More than half of the Portuguese patients presented controlled asthma and showed significantly better asthma-related quality of life. Almost 9 out of 10 patients with non-controlled disease have poor perception of their asthma control, which may hinder them from seeking better asthma control.</p>" ] ] "multimedia" => array:9 [ 0 => array:8 [ "identificador" => "fig1" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "320v21n04-90433950fig1.jpg" "Alto" => 2388 "Ancho" => 3286 "Tamanyo" => 682551 ] ] "descripcion" => array:1 [ "en" => "Relationship between CARAT and mini-AQLQ scores ( <span class="elsevierStyleItalic">n</span> = 274); (A) ARQoL by asthma control groups; Scatterplots show the correlation between (B) CARAT global score and ARQoL; (C) CARAT superior airways subscore and ARQoL; (D) CARAT inferior airways subscore and ARQoL. In A the horizontal line represents the Mini-AQLQ cut-off of 5.4 based on previous study; <span class="elsevierStyleSup">11</span> NCA: non-controlled asthma; CA: Controlled asthma. In (B, C and D) the vertical lines represent the Mini-AQLQ cut-off of 5.4 <span class="elsevierStyleSup">11</span> and the horizontal lines represent the CARAT cut-offs; <span class="elsevierStyleSup">9</span> (B) global score cut-off of 24; (C) superior airways subscore cut-off of 8 and (D) the CARAT inferior subscore cut-off of 16. The scatterplots are divided into four quadrants, the inferior left corresponds to participants with non-controlled disease and more impairments and the upper right to participants with controlled disease and less impairments." ] ] 1 => array:7 [ "identificador" => "fig2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "320v21n04-90433950fig1.jpg" "Alto" => 2388 "Ancho" => 3286 "Tamanyo" => 682551 ] ] "descripcion" => array:1 [ "en" => "Supplementary Fig. S1. Participants Flowchart. From 559 participants 405 had current asthma and 207 had their asthma controlled." ] ] 2 => array:6 [ "identificador" => "fig3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "descripcion" => array:1 [ "en" => "Supplementary Fig. S2. Answers to CARAT questionnaire. Questions 1¿9: dark blue ¿Never¿; yellow ¿Up to 2 days per week¿; orange ¿More than 2 days per week¿; red ¿Almost every day or every day¿. Question 10: light blue ¿Not taking medication¿; dark blue ¿Never¿; orange ¿Less than 7 days¿; red ¿7 or more days¿." ] ] 3 => array:6 [ "identificador" => "fig4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "descripcion" => array:1 [ "en" => "Supplementary Fig. S3. Perceived asthma control by asthma control status. From the 359 participants who answered to the question ¿Did you feel that your asthma was well controlled?¿, 155 had non-controlled asthma and 204 had their asthma controlled, based on CARAT scores." ] ] 4 => array:5 [ "identificador" => "fig5" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" ] 5 => array:6 [ "identificador" => "fig6" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "descripcion" => array:1 [ "en" => "Participants Flowchart. From 559 participants 405 had current asthma and 207 had their asthma controlled." ] ] 6 => array:6 [ "identificador" => "fig7" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "descripcion" => array:1 [ "en" => "Answers to CARAT questionnaire. Questions 1–9: dark blue “Never”; yellow “Up to 2 days per week”; orange “More than 2 days per week”; red “Almost every day or every day”. Question 10: light blue “Not taking medication”; dark blue “Never”; orange “Less than 7 days”; red “7 or more days”." ] ] 7 => array:6 [ "identificador" => "fig8" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "descripcion" => array:1 [ "en" => "Perceived asthma control by asthma control status. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 11 | 5 | 16 |
| 2024 October | 98 | 40 | 138 |
| 2024 September | 126 | 23 | 149 |
| 2024 August | 135 | 47 | 182 |
| 2024 July | 136 | 34 | 170 |
| 2024 June | 137 | 62 | 199 |
| 2024 May | 119 | 44 | 163 |
| 2024 April | 117 | 51 | 168 |
| 2024 March | 120 | 33 | 153 |
| 2024 February | 90 | 37 | 127 |
| 2024 January | 68 | 23 | 91 |
| 2023 December | 93 | 43 | 136 |
| 2023 November | 81 | 46 | 127 |
| 2023 October | 56 | 57 | 113 |
| 2023 September | 63 | 36 | 99 |
| 2023 August | 54 | 28 | 82 |
| 2023 July | 64 | 29 | 93 |
| 2023 June | 62 | 20 | 82 |
| 2023 May | 85 | 40 | 125 |
| 2023 April | 64 | 21 | 85 |
| 2023 March | 124 | 32 | 156 |
| 2023 February | 106 | 33 | 139 |
| 2023 January | 84 | 27 | 111 |
| 2022 December | 108 | 39 | 147 |
| 2022 November | 129 | 49 | 178 |
| 2022 October | 105 | 51 | 156 |
| 2022 September | 59 | 43 | 102 |
| 2022 August | 80 | 42 | 122 |
| 2022 July | 68 | 52 | 120 |
| 2022 June | 75 | 49 | 124 |
| 2022 May | 79 | 43 | 122 |
| 2022 April | 63 | 49 | 112 |
| 2022 March | 77 | 70 | 147 |
| 2022 February | 68 | 50 | 118 |
| 2022 January | 66 | 66 | 132 |
| 2021 December | 53 | 46 | 99 |
| 2021 November | 53 | 40 | 93 |
| 2021 October | 106 | 61 | 167 |
| 2021 September | 55 | 27 | 82 |
| 2021 August | 52 | 28 | 80 |
| 2021 July | 55 | 16 | 71 |
| 2021 June | 58 | 32 | 90 |
| 2021 May | 57 | 44 | 101 |
| 2021 April | 162 | 115 | 277 |
| 2021 March | 101 | 25 | 126 |
| 2021 February | 85 | 47 | 132 |
| 2021 January | 74 | 21 | 95 |
| 2020 December | 54 | 16 | 70 |
| 2020 November | 93 | 17 | 110 |
| 2020 October | 86 | 14 | 100 |
| 2020 September | 73 | 18 | 91 |
| 2020 August | 74 | 19 | 93 |
| 2020 July | 111 | 27 | 138 |
| 2020 June | 97 | 22 | 119 |
| 2020 May | 83 | 19 | 102 |
| 2020 April | 100 | 19 | 119 |
| 2020 March | 79 | 14 | 93 |
| 2020 February | 90 | 25 | 115 |
| 2020 January | 111 | 29 | 140 |
| 2019 December | 75 | 22 | 97 |
| 2019 November | 90 | 37 | 127 |
| 2019 October | 86 | 23 | 109 |
| 2019 September | 96 | 23 | 119 |
| 2019 August | 129 | 20 | 149 |
| 2019 July | 154 | 23 | 177 |
| 2019 June | 169 | 36 | 205 |
| 2019 May | 152 | 37 | 189 |
| 2019 April | 170 | 53 | 223 |
| 2019 March | 189 | 44 | 233 |
| 2019 February | 154 | 14 | 168 |
| 2019 January | 171 | 32 | 203 |
| 2018 December | 84 | 11 | 95 |
| 2018 November | 25 | 1 | 26 |
| 2018 October | 28 | 7 | 35 |
| 2018 September | 17 | 4 | 21 |
| 2018 August | 26 | 24 | 50 |
| 2018 July | 26 | 19 | 45 |
| 2018 June | 21 | 17 | 38 |
| 2018 May | 23 | 15 | 38 |
| 2018 April | 58 | 24 | 82 |
| 2018 March | 42 | 15 | 57 |
| 2018 February | 19 | 12 | 31 |
| 2018 January | 20 | 11 | 31 |
| 2017 December | 31 | 18 | 49 |
| 2017 November | 22 | 17 | 39 |
| 2017 October | 27 | 14 | 41 |
| 2017 September | 28 | 16 | 44 |
| 2017 August | 49 | 19 | 68 |
| 2017 July | 40 | 14 | 54 |
| 2017 June | 47 | 21 | 68 |
| 2017 May | 47 | 14 | 61 |
| 2017 April | 33 | 11 | 44 |
| 2017 March | 38 | 7 | 45 |
| 2017 February | 14 | 7 | 21 |
| 2017 January | 17 | 5 | 22 |
| 2016 December | 6 | 6 | 12 |
| 2016 November | 10 | 2 | 12 |
| 2016 October | 12 | 10 | 22 |
| 2016 September | 24 | 11 | 35 |
| 2016 August | 11 | 6 | 17 |
| 2016 July | 10 | 12 | 22 |
| 2016 June | 0 | 7 | 7 |
| 2016 May | 1 | 9 | 10 |
| 2016 April | 23 | 24 | 47 |
| 2016 March | 44 | 37 | 81 |
| 2016 February | 38 | 39 | 77 |
| 2016 January | 28 | 19 | 47 |
| 2015 December | 35 | 20 | 55 |
| 2015 November | 36 | 18 | 54 |
| 2015 October | 33 | 20 | 53 |
| 2015 September | 42 | 26 | 68 |
| 2015 August | 143 | 85 | 228 |
| 2015 July | 126 | 108 | 234 |
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