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Uncontrolled and severe asthma: predictive factors and comparison of control assessment tools Cover

Uncontrolled and severe asthma: predictive factors and comparison of control assessment tools

Pneumologia
Volume 74 (2025): Issue 1 (January 2025)
By: ,  ,   and    
Open Access
|Dec 2025
Figures & tables

Figures & Tables

Figure 1.

Distribution of Comorbidities among patients with bronchial asthma.

Table 1.

Baseline clinicodemographic data of the studied patients

Variablen = 200 n (%)/mean ± SD median (IQR)
Age (years)35.5 ± 12.9
37 (25.5:45)
Age group110 (55)
  <4084 (42)
  40−<606 (3)
  ≥60
Gender144 (72)
  Female56 (28)
  Male
Smoking20 (10)
BMI (kg/m2)23.4 ± 4.4
22.6 (20.1:25.8)
Classification of BMI10 (5)
  Underweight (<18)140 (70)
  Average (18-25)48 (24)
  Obese (>25)2 (1)
  Morbid obesity (>40)
Exposure
Allergen24 (12)
Air pollution162 (81)
Investigations
FEV1< 60%48 (24)
FEV12.4 ± 0.6
2.4 (2:2.9)
FEV1 percent:74.7 ± 16.5
76 (64.3:86.8)
FVC3 ± 0.7
3.1 (2.6:3.4)
FEV1/FVC ratio79.8 ± 14.6
82 (68.3:91)
High blood eosinophilia54 (27)
>1 severe A.E./year:12 (6)

1 BMI, body mass index; FEV1, forced expiratory volume in one second; FVC, forced vital capacity; FEV1/FVC, ratio of forced expiratory volume in one second to forced vital capacity; IQR, interquartile range; SD, standard deviation

Table 2.

Association between asthma severity and key clinicodemographic variables

VariableMild (n = 38, 19%)Moderate (n = 146, 73%)Severe (n = 16, 8%)P value
Age group <40/40–59/≥6028/10/072/70/410/4/20.01*
Female, n (%)20 (52.6)110 (75.3)14 (87.5)0.007*
DM, n (%)07 (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 ± 0.42.4 ± 0.61.9 ± 0.5<0.001*
FEV1% predicted82.8 ± 13.373.8 ± 1663.5 ± 19.6<0.001*
FVC (L)3.2 ± 0.43.0 ± 0.82.7 ± 0.40.003*
FEV1/FVC ratio89.4 ± 1178.7 ± 14.167.1 ± 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*

1 DM, diabetes mellitus; FEV1, forced expiratory volume in one second; FVC, forced vital capacity; FEV1/FVC, ratio of forced expiratory volume in one second to forced vital capacity; HTN, hypertension; SD, standard deviation.

1 Values are mean ± SD or n (%).

1 *Significant at P < 0.05.

Table 3.

Logistic regression analysis of predictors of severe asthma

VariablesUnivariate analysisMultivariable analysis
Un adjusted OR95% CIP valueAdjusted OR95% CIP value
Age group
  <4010.2:1.70.26---
  40−600.50.8:30.80.08
  >605
Gender0.6:13.20.17---
  Female2.9
  Male1
BMI (kg/m2)0.970.9:1.10.61---
DM8.42.2:32.90.002*4.20.8:21.50.09
Disease duration1.020.97:1.10.51---
Allergen1.10.2:4.90.95---
Air pollution1.020.3:3.80.98---
FEV1<60%12.33.8:40.5<0.001*22.52.7:189.40.004*
FEV1 percent0.960.9:990.006*1.11.03:1.20.006*
FVC0.450.2:10.0530.190.04:0.90.03*
FEV1/FVC ratio0.930.9:0.970.001*0.910.9:0.980.006*
Blood eosinophilia3.41.2:9.60.02*3.70.99:13.80.053

1 BMI, body mass index; CI, confidence interval; DM, diabetes mellitus; FEV1, forced expiratory volume in one second; FVC, forced vital capacity; FEV1/FVC, ratio of forced expiratory volume in one second to forced vital capacity; OR, odds ratio.

Table 4.

Final predictors of severe asthma

VariableAdjusted OR95% CIP value
FEV1< 60%:22.72.9:179.40.003*
FEV1/FVC ratio0.910.9:0.970.004*
FEV1 percent1.11.03:1.20.006*
FVC0.190.05:0.80.03*

1 CI, confidence interval; FEV1, forced expiratory volume in one second; FVC, forced vital capacity; FEV1/FVC, ratio of forced expiratory volume in one second to forced vital capacity; OR, odds ratio.

Table 5.

Association between asthma control and key clinicodemographic variables

VariableControlled (n = 70)Uncontrolled (n = 130)P value
SABA overuse018 (13.8%)0.001*
GERD12 (17.1%)8 (6.2%)0.01*
Allergen exposure4 (5.7%)20 (15.4%)0.045*
FEV1< 60%8 (11.4%)40 (30.8%)0.002*
FEV1 (L)2.6 ± 0.62.3 ± 0.6<0.001*
FEV1% predicted79.9 ± 16.571.9 ± 15.9<0.001*
FVC (L)3.1 ± 0.53.0 ± 0.80.03*
FEV1/FVC ratio84.5 ± 13.777.2 ± 14.50.002*
≥2 severe012 (9.2%)0.009*
exacerbations/year

1 FEV1, forced expiratory volume in one second; FVC, forced vital capacity; FEV1/FVC, ratio of forced expiratory volume in one second to forced vital capacity; GERD, gastroesophageal reflux disease; SABA, short-acting β2-agonist; SD, standard deviation.

1 Values are mean ± SD or n (%).

1 *Significant at P < 0.05.

Table 6.

Logistic regression analysis of predictors of uncontrolled asthma

VariableUnivariate analysisMultivariable analysis
Un adjusted OR95% CIP valueAdjusted OR95% CIP value
Age group
  <401
  ≥400.80.4:1.40.46---
Gender
  Female1
  Male0.960.5:1.80.9---
Smoking1.30.5:3.50.62---
BMI (kg/m2)0.990.9:1.10.7---
DM5.80.7:45.90.13.60.4:30.50.24
HTN2.30.7:8.30.22---
Disease duration0.990.97:10.73---
Inadequate ICS3.50.8:15.90.111.50.3:8.60.62
Non-prescribed ICS1.10.5:2.30.8---
Allergen30.98:9.20.0544.51.3:15.80.02*
Air pollution0.830.4:1.80.62---
Occurrence of exacerbations0.930.5:1.90.83---
FEV1< 60%3.41.5:7.90.003*1.80.6:5.40.32
FEV10.450.3:0.70.002*0.580.3:1.10.09
FEV1 percent0.970.95:0.990.00110.9:1.030.94
FVC0.810.5:1.20.33---
FEV1/FVC ratio0.960.9:0.990.001*0.990.96:1.030.7
Blood eosinophilia0.940.5:1.80.86---

1 BMI, body mass index; CI, confidence interval; DM, diabetes mellitus; FEV1, forced expiratory volume in one second; FVC, forced vital capacity; FEV1/FVC, ratio of forced expiratory volume in one second to forced vital capacity; HTN, hypertension; ICS, inhaled corticosteroid; OR, odds ratio.

Table 7.

Final predictors of uncontrolled asthma

VariableAdjusted OR95% CIP value
Allergen5.11.5:17.30.01*
FEV10.550.3:0.990.047*

1 CI, confidence interval; FEV1, forced expiratory volume in one second; OR, odds ratio.

Table 8.

Agreement between GINA, ACT and ACQ scores classifications

VariableGINA scoreKappaP value
ControlledUncontrolled
ACT score
Controlled44 (62.9)14 (10.8)
Uncontrolled26 (37.1)116 (89.2)0.54<0.001*
ACQ score
Controlled48 (68.6)12 (9.2)
Uncontrolled22 (31.4)118 (90.8)0.61<0.001*

1 ACQ, asthma control questionnaire; ACT, asthma control test; GINA, global initiative for asthma.

Figure 2.

Control of asthma among the studied patients by GINA score, ACT and ACQ.

Figure 3.

ROC curve of diagnostic performance of ACT, ACQ scores in prediction of uncontrolled asthma.

Table 9.

Diagnostic performance of ACT and ACQ scores in the prediction of uncontrolled asthma according to GINA classification

VariableAUC (%)95% CIP valueCutoff pointSensitivity (%)Specificity (%)PPV (%)NPV (%)Accuracy (%)
ACT790.7:0.9<0.001*18.566.277.184.355.170
ACQ89.60.9:0.94<0.001*0.981.585.791.471.483

1 ACQ, asthma control questionnaire; ACT, asthma control test; AUC, area under the curve; CI, confidence interval.

DOI: https://doi.org/10.2478/pneum-2025-0033 | Journal eISSN: 2247-059X | Journal ISSN: 2067-2993
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Language: English, Romanian
Page range: 101 - 111
Published on: Dec 31, 2025
Published by: Romanian Society of Pneumology
In partnership with: Paradigm Publishing Services
Publication frequency: Volume open
Keywords:
asthma,
severity,
control,
FEV1,
ACT,
ACQ
Related subjects:
Medicine,
Clinical medicine,
Clinical medicine, other,
Internal medicine,
Pneumology

© 2025 Enas Khalifa Ahmed, K. A. Abdellah Hamed, Doha Mohamed Ismail, Kamal A. Ata, published by Romanian Society of Pneumology
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 License.

Volume 74 (2025): Issue 1 (January 2025)
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