Impact of patient-related factors on asthma control

J Asthma. 2008 Mar;45(2):109-13. doi: 10.1080/02770900701815727.


Background: Patient-related factors are a significant component in the serious public health problem of poor asthma control, yet they have not been extensively studied.

Aims: To gauge the impact of baseline patient characteristics, compliance and inhaler device manipulation on Asthma Control Score (ACS).

Methods: ACS (between 0 and 9) was calculated from data recorded in a routine consultation in 4,362 patients with persistent asthma using a maintenance treatment with only inhaled corticosteroid and correlated with patient characteristics, compliance (using 2 methods) and critical errors in inhaler handling.

Results: Mean ASC was 2.95 (95%CI: 2.88-3.02) and asthma control was unsatisfactory (i.e., ACS > or = 4) in 41.1% of subjects, with higher proportions in smokers, non-compliant patients, and those misusing their device. Mean ACS tended to rise with age, and was higher in smokers than in non-smokers (+0.83 point) and ex-smokers (+0.49 point). More than 20% of all subjects were using their inhaler device incorrectly (Turbuhaler 37.1%; Metered-dose inhaler 28.1%; Diskus 21.3%; Aerolizer 7.4%) and this was associated with a 0.84-point increase in ACS. Mean ACS was lower in the most compliant patients (-0.74 points in the 13.4% with a perfect score on a compliance questionnaire) and much lower than in the least compliant (-1.84 points in the 6.6% who reported missing 4 or more doses per week).

Conclusion: Patient-related factors including smoking, poor compliance and critical errors in device manipulation, have significant negative impact on asthma control. This could be addressed by patient education.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Administration, Inhalation
  • Adult
  • Asthma / drug therapy*
  • Cross-Sectional Studies
  • Female
  • France
  • Glucocorticoids / administration & dosage*
  • Humans
  • Male
  • Middle Aged
  • Nebulizers and Vaporizers
  • Patient Compliance*
  • Patient Education as Topic*
  • Risk Factors
  • Smoking
  • Treatment Refusal*


  • Glucocorticoids