Smoking, Urban Housing and Work-Aggravated Asthma are Associated with Asthma Severity in a Cross-Sectional Observational Study

Abstract

Purpose

Severe asthma affects 5 to 10% of asthmatics and accounts for a large part of asthma-related morbidity and costs. The determinants of asthma severity are poorly understood. We tested the hypothesis that asthma severity was associated with 1) atopy and allergy and 2) markers associated with environmental exposure.

Patients and Methods

Data from the FASE-CPHG study, a cross-sectional, observational, multicenter investigation, were analyzed to identify markers associated with asthma severity. Asthma severity was gauged using the ASSESS score, encompassing symptom control, exacerbations, FEV1 and therapeutic load. Bivariate and multivariate analyses were used to identify patient characteristics associated with the ASSESS score.

Results

The analysis involved 948 patients, with 592 women, of which 447 patients (47%) had severe asthma. Among these, 491 patients (52%) had at least one positive aeroallergen skin prick test and 525 (55%) had at least one allergic disease among atopic dermatitis, chronic rhinitis and food allergy. The mean±SD ASSESS score was 11.2±3.4. Characteristics associated with a higher ASSESS score were female sex, secondary or lower education, unemployed occupational status, smoking, work-aggravated asthma and urban housing. There was no association between the ASSESS score and allergic diseases, aeroallergen-specific skin prick tests and IgEs, or blood eosinophil counts.

Conclusion

While atopy and allergy were frequent among asthmatics, neither was associated with asthma severity. Modifiable environmental factors such as smoking, urban housing and work-aggravated asthma were independently associated with asthma severity.

Keywords:

• allergy
• ASSESS
• asthma
• environment
• severity

Abbreviation

ACT, Asthma Control Test; ASSESS, Asthma Severity Scoring System; LABA, Long-acting beta agonists; LAMA, Long-acting muscarinic antagonists; FEV1, Forced Expiratory Volume in 1 second; ICS, inhaled corticosteroids; SABA, Short-acting bronchodilators; FASE-CPHG, France Asthme Sévère-Collège des Pneumologues des Hôpitaux Généraux; GINA, Global Initiative for Asthma.

Acknowledgments

The FASE-CPHG study was supported by contributions made through the CPHG from ALK, AstraZeneca, Boehringer Ingelheim, GSK, and Le Nouveau Souffle. Work specifically related to the present manuscript was not funded. The authors thank the Collège des Pneumologues des Hôpitaux Généraux (CPHG, France) which initiated the FASE-CPHG study and Kappa Santé (Paris, France) for the management of collected data. The sponsors of the FASE-CPHG study funded data collection. They had no role in conducting data analysis related to the present study.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

The authors declare no conflicts of interest in this work.