Asthma Clinical Trial
Official title:
A 3 Year Longitudinal Study of the Level of Asthma Control and Treatment of Asthma Patients in Hong Kong
This is a prospective cohort study that aims to determine the current demographics, clinical
characteristics, comorbidities, treatment status and exacerbations of asthma patients.
The primary objective of this study is to determine the current demographics, clinical
characteristics, comorbidities, treatment status and exacerbations of asthma patients.
The secondary objectives include: (1) to review the current practices of symptom control
assessment, (2) to determine the choice of pharmacological regimen, rate of guideline
adherence and real-world clinical practice in managing asthma patients, (3) to evaluate the
pattern of lung function parameters (spirometry and forced oscillometry technique [FOT]) in
adult asthma patients, (4) to evaluate the effect of ageing on the trend of change in lung
function parameters (spirometry and FOT) in adult asthma patients, (5) to identify biomarkers
that help to categorize different asthma phenotypes and predict subsequent prognosis, (6) to
determine the risk factors of uncontrolled asthma and asthma exacerbation, (7) to evaluate
the impact of comorbidities on asthma control.
400 out-patient asthma patients are planned to be recruited and they will be followed up for
3 years.
Asthma is a common respiratory disease worldwide and in Hong Kong. According to the
estimation by the Center for Disease Control and Prevention in 2015, 7.6% adults in the
United States have asthma. In Hong Kong, the prevalence of asthma was estimated to be 10.1%
among 13 to 14 years old children and 5.8% in randomly selected Chinese elderly aged more
than 70. With a rising trend of life expectancy in Hong Kong, the epidemiology of asthma in
adult and elderly population may change over time. In addition, elderly patients with asthma
may present with a different spectrum of clinical characteristics and pharmacological
response.
Asthmatic exacerbation is one of the untoward complications and hospitalization for
exacerbations requiring ICU care and mechanical ventilation are both predictors for
near-fatal asthma. After the acute attack, its unfavourable impact continues and can lead to
multiple sequelae. Exacerbation of asthma is associated with a more rapid decline in the
post-bronchodilator forced expiratory volume in 1 second and worse quality of life. Without
adjustment of medical treatment, they are prone to develop another episode of exacerbation
within a short period of time. In addition, individuals with uncontrolled asthma had higher
medical expenditures and decreased productivity, contributing to a greater economic burden
when compared with individuals without asthma. In contrary, patients with controlled asthma
had lower hospitalization rate, mortality rate and less lung function decline. Many risk
factors for exacerbation had been identified including upper airway diseases,
gastroesophageal reflux, poor inhaler technique, medication non-compliance. Many of these
factors are potentially reversible. A model of better asthma care may be established by
improving the understanding on these risk factors, leading to less exacerbation events.
Asthma is not simply an airway disease. Accumulating evidence showed its coexistence with
other upper airway and systemic diseases, both atopic and non-atopic. These comorbidities
independently or linked together to impose negative impact on patients' health status and
quality of life. Knowing about the burden of asthma related comorbidities may help to guide
clinician in managing these complications in a more effective way, and even prediction of
subsequent prognosis.
Since the launching of GINA guideline in year 1993, its regular evidence-based update on
pharmacological treatment had revolutionize the care of asthma patients. The use of asthma
medications by both specialists and primary care physicians became more structured and the
asthma control was improved. However, there is still a significant proportion of asthma
patients experiencing recurrent exacerbation despite optimization of pharmacological
treatment. Both the guideline adherence by physicians and drug compliance by patient are
subjects of concern.
Previous evidence showed that the compliance rate of GINA guideline is far from satisfactory,
which is a shared phenomenon among different common diseases even the presence of
well-established international guideline. Patient's drug compliance also contributes to
negative disease outcome, especially non-adherence to inhaled corticosteroid. Currently, a
comprehensive view on the treatment status in and level of asthma control in Hong Kong is
still lacking.
A large knowledge gap exists between the current demographics, comorbidities, treatment
status, level of asthma control and exacerbations in Hong Kong. An updated study on these
aspects is definitely warranted to enhance patient care and guide further research.
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