Asthma Burden in Mild Adult Asthma in the PEARL Survey: Asthma Control and Health Status.

Abstract

Asthma classified as "mild" is commonly assumed to have a low symptom burden and limited impact on quality of life. To characterize patient-reported asthma burden among adults with mild asthma identified using electronic health record-based criteria. A total of 3787 adults aged 18-85 years completed a survey assessing asthma burden. Asthma control and health-related quality of life (HRQOL) were measured using the Asthma Impairment and Risk Questionnaire (AIRQ) and the Veterans RAND 12-item Health Survey (VR-12), respectively. Investigator-developed items were used to assess symptoms, functional impact, and health care utilization in the prior year. Associations between patient characteristics and prespecified outcomes-very poorly controlled asthma in the past 2 weeks, symptoms ≥2 days/wk, and ≥2 patient-reported asthma-related emergency department (ED) or urgent care (UC) visits in the prior year-were evaluated using multivariable analyses. Asthma control was distributed across AIRQ categories as follows: 34.6% well controlled, 32.9% not well controlled, and 32.5% very poorly controlled. Patient-reported burden was notable: 27.6% reported symptoms at least a few times per week, 52.7% reported systemic corticosteroid use ever, and 41.4% reported ≥1 ED/UC visit in the prior year, including 19.7% with ≥2 visits. The mean [standard deviation] VR-12 scores indicated impaired HRQOL (physical component summary: 43.3 [9.7]; mental component summary: 44.7 [11.8]). Hispanic/Latino and Black/African American patients had higher risks of very poorly controlled asthma and ≥2 ED/UC visits in the prior year compared with non-Hispanic White patients. Adults with utilization-defined mild asthma report substantial burden across multiple domains, which provides an unanticipated patient-reported perspective on asthma burden in this population.