Education and management of medical care integration to improve asthma control: a prospective cohort study in a real-world setting_Chinese Journal of Evidence-Based Medicine

Authors：

YANG Liu ¹ , WANG Yali ² , ZHENG Liangxia ¹ , DENG Ke ^2,3 , LIU Lei ^2,3,4 , HE Xiaoli ¹ ,  ZHAO Shuzeng ¹ ,  WANG Gang ^2,3

1. Department of Outpatient, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;
2. Department of Respiratory and Critical Care Medicine, Clinical Research Center for Respiratory Disease, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;
3. Laboratory of Pulmonary Immunology and Inflammation, Frontiers Science Center for Disease-related Molecular Network, Sichuan University, Chengdu 610041, P. R. China;
4. Department of Integrated Traditional Chinese and Western Medicine, Clinical Research Center for Respiratory Disease, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;

Corresponding author：

ZHAO Shuzeng, Email: wong-gang@126.com; WANG Gang, Email: wong-gang@126.com

Keywords：

Asthma; Real-world setting; Adherence; Asthma control; Exacerbation

DOI：

10.7507/1672-2531.202109013

Video：

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Objective To explore whether education and management of medical care integration can improve asthma control. Methods A prospective, 12-month, cohort study was undertaken in a real-world setting based on Australasian severe asthma network (ASAN). A total of 516 patients with stable asthma were consecutively recruited, who received education and management of medical care integration, and step-wise anti-asthma regimens determined by physicians’ standard practice. Furthermore, inhaled corticosteroid (ICS) adherence, lung function, asthma symptom control and exacerbation were assessed at 1, 3, 6, and 12 months. Results At the end of 12 months, ICS adherence (47.7% vs. 81.5%, P<0.05), lung function, and asthma symptoms were assessed by asthma control text (ACT) [20 (16, 23) vs. 23 (21, 24), P<0.05], which were significantly improved in comparison to the status at baseline, and 86.0% of patients achieved total/well-controlled level of asthma. The exacerbation (14.2% vs. 36.2%, P<0.01) and hospitalizations (8.5% vs. 15.3%, P<0.01) because of asthma for the following year significantly decreased compared with those in the past year. The multivariate regression analysis indicated that poor ICS adherence (RR=1.52, 95%CI 1.02 to 2.25, P=0.039), depression symptoms (RR=1.19, 95%CI 1.05 to 1.34, P=0.007), and exacerbation during the past year (RR=2.81, 95%CI 1.49 to 5.27, P=0.001) were associated with an increased risk of future exacerbation. Conclusion In a real-world setting, most of asthmatics achieve total/well-controlled asthma by education and management of medical care integration including shared decision-making between physicians and patients and step-wise anti-asthma regimens. ICS adherence and depression symptoms independently predict asthma exacerbations, and strengthening education and management of medical care integration, esp. psychological nursing, would improve asthma control levels.

Citation： YANG Liu, WANG Yali, ZHENG Liangxia, DENG Ke, LIU Lei, HE Xiaoli, ZHAO Shuzeng, WANG Gang. Education and management of medical care integration to improve asthma control: a prospective cohort study in a real-world setting. Chinese Journal of Evidence-Based Medicine, 2022, 22(2): 140-147. doi: 10.7507/1672-2531.202109013 Copy

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2.	Global Initiative for Asthma. Global strategy for asthma management and prevention: update 2019. Available at: http://www.ginaasthma.org/.
3.	林江涛. 达到哮喘总体控制是实施有效哮喘管理的核心. 中华内科杂志, 2014, 53(8): 594-595.
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5.	林江涛, 王文巧, 王长征, 等. 我国30个省市城区门诊支气管哮喘患者控制水平的调查结果. 中华结核和呼吸杂志, 2017, 40(7): 494-498.
6.	林江涛, 王文巧, 殷凯生, 等. 我国十城市支气管哮喘控制和疾病管理及患者认知水平的变化. 中华结核和呼吸杂志, 2018, 41(3): 191-195.
7.	Wang G, Wang F, Gibson PG, et al. Severe and uncontrolled asthma in China: a cross-sectional survey from the Australasian severe asthma network. J Thorac Dis, 2017, 9(5): 1333-1344.
8.	Han YY, Zhang X, Wang J, et al. Multidimensional assessment of asthma identifies clinically relevant phenotype overlap: a cross-sectional study. J Allergy Clin Immunol Pract, 2021, 9(1): 349-362.
9.	Wu WW, Zhang X, Li M, et al. Treatable traits in elderly asthmatics from the Australasian severe asthma network: a prospective cohort study. J Allergy Clin Immunol Pract, 2021, 9(7): 2770-2782.
10.	Deng K, Zhang X, Liu Y, et al. Heterogeneity of paucigranulocytic asthma: a prospective cohort study with hierarchical cluster analysis. J Allergy Clin Immunol Pract, 2021, 9(6): 2344-2355.
11.	胡群, 吴雯雯, 姬郁林, 等. 多维度评估识别重症支气管哮喘可治疗特质. 中国呼吸与危重症监护杂志, 2021, 20(4): 282-288.
12.	刘蕾, 王蕾, 王刚. 共同决策与哮喘管理. 中国呼吸与危重监护杂志, 2018, 17(1): 88-92.
13.	d'Ancona G, Kavanagh J, Roxas C, et al. Adherence to corticosteroids and clinical outcomes in mepolizumab therapy for severe asthma. Eur Respir J, 2020, 55(5): 1902259.
14.	Graham BL, Steenbruggen I, Miller MR, et al. Standardization of spirometry 2019 update. An official American thoracic society and European respiratory society technical statement. Am J Respir Crit Care Med, 2019, 200(8): e70-e88.
15.	Bjelland I, Dahl AA, Haug TT, et al. The validity of the hospital anxiety and depression scale. An updated literature review. J Psychosom Res, 2002, 52(2): 69-77.
16.	Zheng LL, Wang YL, Li HC. Application of hospital anxiety and depression scale in general hospital: an analysis in reliability and validity. Shanghai Arch Psychiatry, 2003, 15(5): 264-266.
17.	Ye WF, Xu JM. Application and assessment of hospital anxiety and depression scale in general hospital. Chin J Behavioral Med Sci, 1993, 2(3): 17-19.
18.	Nathan RA, Sorkness CA, Kosinski M, et al. Development of the asthma control test: a survey for assessing asthma control. J Allergy Clin Immunol, 2004, 113(1): 59-65.
19.	Juniper EF, O'Byrne PM, Guyatt GH, et al. Development and validation of a questionnaire to measure asthma control. Eur Respir J, 1999, 14(4): 902-907.
20.	Jia CE, Zhang HP, Lv Y, et al. The asthma control test and asthma control questionnaire for assessing asthma control: systematic review and meta-analysis. J Allergy Clin Immunol, 2013, 131(3): 695-703.
21.	Juniper EF, Guyatt GH, Ferrie PJ, et al. Measuring quality of life in asthma. Am Rev Respir Dis, 1993, 147(4): 832-838.
22.	Reddel HK, Taylor DR, Bateman ED, et al. An official American Thoracic Society/European Respiratory Society statement: asthma control and exacerbations: standardizing endpoints for clinical asthma trials and clinical practice. Am J Respir Crit Care Med, 2009, 180(1): 59-99.
23.	Racine G, Forget A, Moullec G, et al. Predictors of asthma control and exacerbations: a real-world study. J Allergy Clin Immunol Pract, 2021, 9(7): 2802-2811.
24.	Wang G, Zhang X, Zhang HP, et al. Corticosteroid plus β 2-agonist in a single inhaler as reliever therapy in intermittent and mild asthma: a proof-of-concept systematic review and meta-analysis. Respir Res, 2017, 18(1): 203.
25.	Kulikova A, Lopez J, Antony A, et al. Multivariate association of child depression and anxiety with asthma outcomes. J Allergy Clin Immunol Pract, 2021, 9(6): 2399-2405.
26.	Freitas PD, Xavier RF, McDonald VM, et al. Identification of asthma phenotypes based on extrapulmonary treatable traits. Eur Respir J, 2021, 57(1): 2000240.
27.	Jackson DJ, Busby J, Pfeffer PE, et al. Characterization of patients with severe asthma in the UK severe asthma registry in the biologic era. Thorax, 2021, 76(3): 220-227.
28.	Zhang L, Zhang X, Zheng J, et al. Depressive symptom-associated IL-1β and TNF-α release correlates with impaired bronchodilator response and neutrophilic airway inflammation in asthma. Clin Exp Allergy, 2019, 49(6): 770-780.

1. 中华医学会呼吸病学分会哮喘学组. 支气管哮喘防治指南(2020年版). 中华结核和呼吸杂志, 2020, 43(12): 1023-1048.
2. Global Initiative for Asthma. Global strategy for asthma management and prevention: update 2019. Available at: http://www.ginaasthma.org/.
3. 林江涛. 达到哮喘总体控制是实施有效哮喘管理的核心. 中华内科杂志, 2014, 53(8): 594-595.
4. Bateman ED, Boushey HA, Bousquet J, et al. Can guideline-defined asthma control be achieved. The gaining optimal asthma control study. Am J Respir Crit Care Med, 2004, 170(8): 836-844.
5. 林江涛, 王文巧, 王长征, 等. 我国30个省市城区门诊支气管哮喘患者控制水平的调查结果. 中华结核和呼吸杂志, 2017, 40(7): 494-498.
6. 林江涛, 王文巧, 殷凯生, 等. 我国十城市支气管哮喘控制和疾病管理及患者认知水平的变化. 中华结核和呼吸杂志, 2018, 41(3): 191-195.
7. Wang G, Wang F, Gibson PG, et al. Severe and uncontrolled asthma in China: a cross-sectional survey from the Australasian severe asthma network. J Thorac Dis, 2017, 9(5): 1333-1344.
8. Han YY, Zhang X, Wang J, et al. Multidimensional assessment of asthma identifies clinically relevant phenotype overlap: a cross-sectional study. J Allergy Clin Immunol Pract, 2021, 9(1): 349-362.
9. Wu WW, Zhang X, Li M, et al. Treatable traits in elderly asthmatics from the Australasian severe asthma network: a prospective cohort study. J Allergy Clin Immunol Pract, 2021, 9(7): 2770-2782.
10. Deng K, Zhang X, Liu Y, et al. Heterogeneity of paucigranulocytic asthma: a prospective cohort study with hierarchical cluster analysis. J Allergy Clin Immunol Pract, 2021, 9(6): 2344-2355.
11. 胡群, 吴雯雯, 姬郁林, 等. 多维度评估识别重症支气管哮喘可治疗特质. 中国呼吸与危重症监护杂志, 2021, 20(4): 282-288.
12. 刘蕾, 王蕾, 王刚. 共同决策与哮喘管理. 中国呼吸与危重监护杂志, 2018, 17(1): 88-92.
13. d'Ancona G, Kavanagh J, Roxas C, et al. Adherence to corticosteroids and clinical outcomes in mepolizumab therapy for severe asthma. Eur Respir J, 2020, 55(5): 1902259.
14. Graham BL, Steenbruggen I, Miller MR, et al. Standardization of spirometry 2019 update. An official American thoracic society and European respiratory society technical statement. Am J Respir Crit Care Med, 2019, 200(8): e70-e88.
15. Bjelland I, Dahl AA, Haug TT, et al. The validity of the hospital anxiety and depression scale. An updated literature review. J Psychosom Res, 2002, 52(2): 69-77.
16. Zheng LL, Wang YL, Li HC. Application of hospital anxiety and depression scale in general hospital: an analysis in reliability and validity. Shanghai Arch Psychiatry, 2003, 15(5): 264-266.
17. Ye WF, Xu JM. Application and assessment of hospital anxiety and depression scale in general hospital. Chin J Behavioral Med Sci, 1993, 2(3): 17-19.
18. Nathan RA, Sorkness CA, Kosinski M, et al. Development of the asthma control test: a survey for assessing asthma control. J Allergy Clin Immunol, 2004, 113(1): 59-65.
19. Juniper EF, O'Byrne PM, Guyatt GH, et al. Development and validation of a questionnaire to measure asthma control. Eur Respir J, 1999, 14(4): 902-907.
20. Jia CE, Zhang HP, Lv Y, et al. The asthma control test and asthma control questionnaire for assessing asthma control: systematic review and meta-analysis. J Allergy Clin Immunol, 2013, 131(3): 695-703.
21. Juniper EF, Guyatt GH, Ferrie PJ, et al. Measuring quality of life in asthma. Am Rev Respir Dis, 1993, 147(4): 832-838.
22. Reddel HK, Taylor DR, Bateman ED, et al. An official American Thoracic Society/European Respiratory Society statement: asthma control and exacerbations: standardizing endpoints for clinical asthma trials and clinical practice. Am J Respir Crit Care Med, 2009, 180(1): 59-99.
23. Racine G, Forget A, Moullec G, et al. Predictors of asthma control and exacerbations: a real-world study. J Allergy Clin Immunol Pract, 2021, 9(7): 2802-2811.
24. Wang G, Zhang X, Zhang HP, et al. Corticosteroid plus β 2-agonist in a single inhaler as reliever therapy in intermittent and mild asthma: a proof-of-concept systematic review and meta-analysis. Respir Res, 2017, 18(1): 203.
25. Kulikova A, Lopez J, Antony A, et al. Multivariate association of child depression and anxiety with asthma outcomes. J Allergy Clin Immunol Pract, 2021, 9(6): 2399-2405.
26. Freitas PD, Xavier RF, McDonald VM, et al. Identification of asthma phenotypes based on extrapulmonary treatable traits. Eur Respir J, 2021, 57(1): 2000240.
27. Jackson DJ, Busby J, Pfeffer PE, et al. Characterization of patients with severe asthma in the UK severe asthma registry in the biologic era. Thorax, 2021, 76(3): 220-227.
28. Zhang L, Zhang X, Zheng J, et al. Depressive symptom-associated IL-1β and TNF-α release correlates with impaired bronchodilator response and neutrophilic airway inflammation in asthma. Clin Exp Allergy, 2019, 49(6): 770-780.

Chinese Journal of Evidence-Based Medicine

Education and management of medical care integration to improve asthma control: a prospective cohort study in a real-world setting

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