Figure 1.
Figure 2.
Figure 3.
Agreement between GINA, ACT and ACQ scores classifications
| Variable | GINA score | Kappa | P value | |
|---|---|---|---|---|
| Controlled | Uncontrolled | |||
| ACT score | ||||
| Controlled | 44 (62.9) | 14 (10.8) | ||
| Uncontrolled | 26 (37.1) | 116 (89.2) | 0.54 | <0.001* |
| ACQ score | ||||
| Controlled | 48 (68.6) | 12 (9.2) | ||
| Uncontrolled | 22 (31.4) | 118 (90.8) | 0.61 | <0.001* |
Logistic regression analysis of predictors of severe asthma
| Variables | Univariate analysis | Multivariable analysis | ||||
|---|---|---|---|---|---|---|
| Un adjusted OR | 95% CI | P value | Adjusted OR | 95% CI | P value | |
| Age group | ||||||
| <40 | 1 | 0.2:1.7 | 0.26 | - | - | - |
| 40−60 | 0.5 | 0.8:30.8 | 0.08 | |||
| >60 | 5 | |||||
| Gender | 0.6:13.2 | 0.17 | - | - | - | |
| Female | 2.9 | |||||
| Male | 1 | |||||
| BMI (kg/m2) | 0.97 | 0.9:1.1 | 0.61 | - | - | - |
| DM | 8.4 | 2.2:32.9 | 0.002* | 4.2 | 0.8:21.5 | 0.09 |
| Disease duration | 1.02 | 0.97:1.1 | 0.51 | - | - | - |
| Allergen | 1.1 | 0.2:4.9 | 0.95 | - | - | - |
| Air pollution | 1.02 | 0.3:3.8 | 0.98 | - | - | - |
| FEV1<60% | 12.3 | 3.8:40.5 | <0.001* | 22.5 | 2.7:189.4 | 0.004* |
| FEV1 percent | 0.96 | 0.9:99 | 0.006* | 1.1 | 1.03:1.2 | 0.006* |
| FVC | 0.45 | 0.2:1 | 0.053 | 0.19 | 0.04:0.9 | 0.03* |
| FEV1/FVC ratio | 0.93 | 0.9:0.97 | 0.001* | 0.91 | 0.9:0.98 | 0.006* |
| Blood eosinophilia | 3.4 | 1.2:9.6 | 0.02* | 3.7 | 0.99:13.8 | 0.053 |
Baseline clinicodemographic data of the studied patients
| Variable | n = 200 n (%)/mean ± SD median (IQR) |
|---|---|
| Age (years) | 35.5 ± 12.9 |
| Age group | 110 (55) |
| <40 | 84 (42) |
| 40−<60 | 6 (3) |
| ≥60 | |
| Gender | 144 (72) |
| Female | 56 (28) |
| Male | |
| Smoking | 20 (10) |
| BMI (kg/m2) | 23.4 ± 4.4 |
| Classification of BMI | 10 (5) |
| Underweight (<18) | 140 (70) |
| Average (18-25) | 48 (24) |
| Obese (>25) | 2 (1) |
| Morbid obesity (>40) | |
| Exposure | |
| Allergen | 24 (12) |
| Air pollution | 162 (81) |
| Investigations | |
| FEV1< 60% | 48 (24) |
| FEV1 | 2.4 ± 0.6 |
| FEV1 percent: | 74.7 ± 16.5 |
| FVC | 3 ± 0.7 |
| FEV1/FVC ratio | 79.8 ± 14.6 |
| High blood eosinophilia | 54 (27) |
| >1 severe A.E./year: | 12 (6) |
Final predictors of severe asthma
| Variable | Adjusted OR | 95% CI | P value |
|---|---|---|---|
| FEV1< 60%: | 22.7 | 2.9:179.4 | 0.003* |
| FEV1/FVC ratio | 0.91 | 0.9:0.97 | 0.004* |
| FEV1 percent | 1.1 | 1.03:1.2 | 0.006* |
| FVC | 0.19 | 0.05:0.8 | 0.03* |
Diagnostic performance of ACT and ACQ scores in the prediction of uncontrolled asthma according to GINA classification
| Variable | AUC (%) | 95% CI | P value | Cutoff point | Sensitivity (%) | Specificity (%) | PPV (%) | NPV (%) | Accuracy (%) |
|---|---|---|---|---|---|---|---|---|---|
| ACT | 79 | 0.7:0.9 | <0.001* | 18.5 | 66.2 | 77.1 | 84.3 | 55.1 | 70 |
| ACQ | 89.6 | 0.9:0.94 | <0.001* | 0.9 | 81.5 | 85.7 | 91.4 | 71.4 | 83 |
Association between asthma severity and key clinicodemographic variables
| Variable | Mild (n = 38, 19%) | Moderate (n = 146, 73%) | Severe (n = 16, 8%) | P value |
|---|---|---|---|---|
| Age group <40/40–59/≥60 | 28/10/0 | 72/70/4 | 10/4/2 | 0.01* |
| Female, n (%) | 20 (52.6) | 110 (75.3) | 14 (87.5) | 0.007* |
| DM, n (%) | 0 | 7 (4.8) | 4 (25) | 0.004* |
| HTN, n (%) | 1 (2.6) | 10 (6.8) | 4 (25) | 0.02* |
| Air pollution exposure, n (%) | 21 (55.3) | 128 (87.7) | 13 (81.3) | <0.001* |
| FEV1<60%, n (%) | 2 (5.3) | 34 (23.3) | 12 (75) | <0.001* |
| FEV1 (L) | 2.8 ± 0.4 | 2.4 ± 0.6 | 1.9 ± 0.5 | <0.001* |
| FEV1% predicted | 82.8 ± 13.3 | 73.8 ± 16 | 63.5 ± 19.6 | <0.001* |
| FVC (L) | 3.2 ± 0.4 | 3.0 ± 0.8 | 2.7 ± 0.4 | 0.003* |
| FEV1/FVC ratio | 89.4 ± 11 | 78.7 ± 14.1 | 67.1 ± 14.1 | <0.001* |
| High blood eosinophilia, n (%) | 8 (21.1) | 36 (24.7) | 10 (62.5) | 0.003* |
| ≥2 severe exacerbations/year, n (%) | 4 (10.5) | 5 (3.4) | 3 (18.8) | 0.03* |
Association between asthma control and key clinicodemographic variables
| Variable | Controlled (n = 70) | Uncontrolled (n = 130) | P value |
|---|---|---|---|
| SABA overuse | 0 | 18 (13.8%) | 0.001* |
| GERD | 12 (17.1%) | 8 (6.2%) | 0.01* |
| Allergen exposure | 4 (5.7%) | 20 (15.4%) | 0.045* |
| FEV1< 60% | 8 (11.4%) | 40 (30.8%) | 0.002* |
| FEV1 (L) | 2.6 ± 0.6 | 2.3 ± 0.6 | <0.001* |
| FEV1% predicted | 79.9 ± 16.5 | 71.9 ± 15.9 | <0.001* |
| FVC (L) | 3.1 ± 0.5 | 3.0 ± 0.8 | 0.03* |
| FEV1/FVC ratio | 84.5 ± 13.7 | 77.2 ± 14.5 | 0.002* |
| ≥2 severe | 0 | 12 (9.2%) | 0.009* |
| exacerbations/year |
Logistic regression analysis of predictors of uncontrolled asthma
| Variable | Univariate analysis | Multivariable analysis | ||||
|---|---|---|---|---|---|---|
| Un adjusted OR | 95% CI | P value | Adjusted OR | 95% CI | P value | |
| Age group | ||||||
| <40 | 1 | |||||
| ≥40 | 0.8 | 0.4:1.4 | 0.46 | - | - | - |
| Gender | ||||||
| Female | 1 | |||||
| Male | 0.96 | 0.5:1.8 | 0.9 | - | - | - |
| Smoking | 1.3 | 0.5:3.5 | 0.62 | - | - | - |
| BMI (kg/m2) | 0.99 | 0.9:1.1 | 0.7 | - | - | - |
| DM | 5.8 | 0.7:45.9 | 0.1 | 3.6 | 0.4:30.5 | 0.24 |
| HTN | 2.3 | 0.7:8.3 | 0.22 | - | - | - |
| Disease duration | 0.99 | 0.97:1 | 0.73 | - | - | - |
| Inadequate ICS | 3.5 | 0.8:15.9 | 0.11 | 1.5 | 0.3:8.6 | 0.62 |
| Non-prescribed ICS | 1.1 | 0.5:2.3 | 0.8 | - | - | - |
| Allergen | 3 | 0.98:9.2 | 0.054 | 4.5 | 1.3:15.8 | 0.02* |
| Air pollution | 0.83 | 0.4:1.8 | 0.62 | - | - | - |
| Occurrence of exacerbations | 0.93 | 0.5:1.9 | 0.83 | - | - | - |
| FEV1< 60% | 3.4 | 1.5:7.9 | 0.003* | 1.8 | 0.6:5.4 | 0.32 |
| FEV1 | 0.45 | 0.3:0.7 | 0.002* | 0.58 | 0.3:1.1 | 0.09 |
| FEV1 percent | 0.97 | 0.95:0.99 | 0.001 | 1 | 0.9:1.03 | 0.94 |
| FVC | 0.81 | 0.5:1.2 | 0.33 | - | - | - |
| FEV1/FVC ratio | 0.96 | 0.9:0.99 | 0.001* | 0.99 | 0.96:1.03 | 0.7 |
| Blood eosinophilia | 0.94 | 0.5:1.8 | 0.86 | - | - | - |
Final predictors of uncontrolled asthma
| Variable | Adjusted OR | 95% CI | P value |
|---|---|---|---|
| Allergen | 5.1 | 1.5:17.3 | 0.01* |
| FEV1 | 0.55 | 0.3:0.99 | 0.047* |