Update on asthma control in five European countries: results of a 2008 survey

Abstract

The 2006 European National Health and Wellness Survey (NHWS) showed that a large proportion of asthmatics had uncontrolled asthma. The current analysis estimated the prevalence of asthma and asthma control (Asthma Control Test™ (ACT); QualityMetric Inc., Lincoln, RI, USA) in five European countries using the 2008 NHWS. Health-related quality of life (HRQoL), using the Short Form-12 (SF-12) health survey, and work productivity/activity impairment were assessed. Of 3,619 respondents aged ≥18 yrs, the prevalence of self-reported physician diagnosis of asthma was 6.1% (15 million people); 56.6% of treated asthmatics were not well-controlled (NWC; ACT score ≤19). Individual components of the ACT showed that, compared with at least well-controlled patients (ALWC; ACT score ≥20), NWC patients had activity limitations at least some of the time (40.8% versus 1.5%, p<0.001), were breathless ≥3 times per week (72.5% versus 5.4%, p<0.001), suffered sleep difficulties due to asthma at least once per week (60.3% versus 4.6%, p<0.001) and required rescue medication ≥2-3 times per week (77.4% versus 15.9%, p<0.001). NWC patients had also received more healthcare contact in the past 6 ;months, including hospitalisation (17.4% versus 9.9%, p<0.001). The SF-12 physical and mental summary scores were 7.46 and 4.73 points higher, respectively, for ALWC patients compared with NWC patients (p<0.001). ALWC patients reported less absenteeism (5.5% versus 12.2%) and work impairment (15.4% versus 30.0%) than NWC patients (both p<0.001). The proportion of asthmatics with NWC asthma has not improved since 2006. ALWC asthma is associated with a significant positive impact on healthcare resource use, HRQoL and work productivity.

FIGURE 1.

Asthma control index. An asthma control index was computed by country as the ratio of at least well-controlled to not well-controlled treated asthma sufferers. An index of >1 equates to a greater proportion of at least well-controlled and an index of <1 equates to a greater proportion of not well-controlled.

FIGURE 2.

Work productivity and activity impairment by control status. Work productivity impairment considers both absent (time missed from work) and present (impairment while working) results. ░: not well-controlled asthma; ▒: at least well-controlled asthma. Statistical comparisons were computed using the Chi-squared test. ***: p<0.001.

FIGURE 3.

Short-form (SF)-12 mean scores by control status. PCS: physical component score; MCS: mental component score. ░: not well-controlled asthma; ▒: at least well-controlled asthma. Statistical comparisons were computed using the unpaired t-test. ***: p<0.001.