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. 2006 Jul-Aug;13(5):253-9.
doi: 10.1155/2006/753083.

Asthma control in Canada remains suboptimal: the Reality of Asthma Control (TRAC) study

J Mark FitzGerald  1 , Louis-Philipe Boulet, R Andrew McIvor, Sabrina Zimmerman, Kenneth R Chapman
Affiliations

Asthma control in Canada remains suboptimal: the Reality of Asthma Control (TRAC) study

J Mark FitzGerald et al. Can Respir J. 2006 Jul-Aug.

Abstract
in English, French

Background: Two Canadian studies showed that 55% of patients with asthma had daily symptoms (in 1996) and that 57% of patients suffered from poorly controlled asthma (in 1999).

Objectives: To assess the state of asthma control of adult Canadians, and asthma knowledge and practices of Canadian physicians actively involved in the care of patients with asthma.

Methods: Telephone interviews were conducted with adults 18 to 54 years of age who had been diagnosed with asthma at least six months before the survey, who did not have chronic obstructive pulmonary disease and who had a smoking history of fewer than 20 pack-years. Physicians were surveyed by telephone and mail. The surveys took place between April and August 2004.

Results: Almost all (97%) of the 893 patients believed that they had controlled asthma; however, only 47% had controlled disease according to symptom-based guideline criteria. Just 39% of 463 physicians based their treatment recommendations on the Canadian asthma guidelines most or all of the time, despite having a high awareness of them. Only 11% of patients had written action plans, and one-half of patients with action plans did not use them regularly. Almost three-quarters of patients expressed concerns about taking inhaled corticosteroids.

Conclusions: Since the last major national survey, guideline implementation has not resulted in significant changes in asthma-related morbidity. Effective means of knowledge transfer should be developed and implemented to improve the translation of guideline recommendations into care.

HISTORIQUE :: Deux études canadiennes ont révélé que 55 % des patients asthmatiques souffraient de symptômes quotidiens (en 1996) et que 57 % souffraient d’asthme mal contrôlé (en 1999).

OBJECTIFS :: Évaluer l’état du contrôle de l’asthme des adultes canadiens, ainsi que les connaissances sur l’asthme et les pratiques des médecins canadiens qui participent activement aux soins des patients asthmatiques.

MÉTHODOLOGIE :: Des entrevues téléphoniques ont été menées auprès d’adultes de 18 à 54 ans ayant reçu un diagnostic d’asthme au moins six mois avant l’enquête, ne souffrant pas d’une maladie pulmonaire obstructive chronique et fumant moins de 20 paquets-années. Les médecins ont été sondés par téléphone et par la poste. Les enquêtes ont eu lieu entre avril et août 2004.

RÉSULTATS :: Près de la totalité (97 %) des 893 patients pensaient que leur asthme était contrôlé, mais il l’était dans seulement 47 % des cas d’après les critères fondés sur les symptômes des principes directeurs. Seulement 39 % des 463 médecins fondaient presque toujours ou toujours leurs recommandations de traitement sur les principes directeurs du consensus canadien sur l’asthme, même s’ils connaissaient bien ces principes. Seulement 11 % des patients avaient des plans d’action écrits, et la moitié de ceux qui en avaient un ne l’utilisaient pas régulièrement. Près des trois quarts des patients s’inquiétaient de prendre une corticothérapie en aérosol.

CONCLUSIONS :: Depuis la dernière grande enquête nationale, l’implantation des principes directeurs n’a pas entraîné de changements significatifs de la morbidité reliée à l’asthme. Il faudrait élaborer et implanter des moyens efficaces de transmission du savoir pour améliorer le transfert des recommandations issues des principes directeurs en milieu clinique.

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Figures

Figure 1)
Figure 1)
Recruitment and enrollment in The Reality of Asthma Control (TRAC) study. See Table 2 for the derivation of the number of ‘direct contacts’. *From this cohort, patients with no physician diagnosis of asthma, a diagnosis within the previous six months or a smoking history of 20 pack-years or more were excluded. GPs Primary care physicians
Figure 2)
Figure 2)
Uncontrolled asthma in Canada. According to the objective criteria of the Canadian Asthma Consensus Guidelines (CACG) (1), 53% of 893 patients had uncontrolled asthma; however, only 3% of patients thought that their asthma was uncontrolled. Survey question: “Overall, would you say your asthma is very well controlled, somewhat well controlled, not very well controlled, or not at all controlled?” (the response of 97% includes those who answered very well [59%] and somewhat well [38%] controlled). Specialists (n=77) and primary care physicians (GPs) (n=386) also underestimated the percentage of patients with uncontrolled asthma. Survey question: “Overall, do you feel you are achieving control of your patients’ asthma?” (n=463)
Figure 3)
Figure 3)
Physicians’ definition of asthma control. Survey question: “How do you define control for an asthma patient?” (n=463)
Figure 4)
Figure 4)
Percentages of patients taking classes of prescription medications for asthma. Combo Combination of an inhaled corticosteroid (ICS) and a long-acting beta-2-agonist (LABA) in a single inhaler. SABA Short-acting beta-2-agonist
Figure 5)
Figure 5)
Percentages of patients possessing asthma treatment plans. Survey question: “Do you have an asthma treatment plan that is either written or spoken instructions of what to do if your asthma gets worse?”
Figure 6)
Figure 6)
Knowledge of reliever and controller medications in the subsets of patients who had heard of each type of medication (n=594 for relievers; n=661 for controllers). Survey questions: “Have you ever heard of ‘reliever’/‘controller’ medications for asthma?” and “Can you name one or more reliever/controller medications?” (note that respondents were permitted to give more than one answer). The figure categorizes the patients’ examples of relievers (A) and controllers (B). Response percentages (of total drug mentions) may not add up to 100 because of rounding. Combos Combination of an inhaled corticosteroid and a long-acting beta-2-agonist (LABA) in a single inhaler; DK Don’t know; LTRAs Leukotriene-receptor antagonists; NA No answer
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References

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