Validation of asthma management approach according to risk factors
Authors: Farouk Riham A. , Abdel-latif Gamal Abdel-rahman , Dwedar Ibrahim Aly , Abdel-sattar Mohammed Dalia 
Published: February 2023

Background
Although studies show that most people successfully control their asthma, polls consistently show that this is not the case in real life. The present study aimed to validate assessment of asthma control using a risk stratification approach in comparison with global strategy for asthma management and prevention (GINA) guidelines with particular attention to high-risk group of asthmatic patients.

Patients and methods
This was a prospective interventional cohort trial that enrolled 30 patients with asthma in the outpatient department of Ain Shams University Hospital between January 2019 and January 2020. There were 10 female patients and 20 male patients, with a mean age of 51.43 ± 14.94 years. They were enrolled and randomly grouped 1: 1 into group A, which followed asthma risk stratification therapy (ARST), and group B, with the standard GINA approach, within 1-year follow-up period. Following visit 1 in a 2-week interval as a washout period, there were five consecutive visits on 3 months apart, and then visit 6 at the end of treatment at a 2-week interval. All patients were subjected to the Asthma Control Test Questionnaire for assessment of asthma control by GINA approach and to objective control assessments in ARST by Morisky Medication Adherence Scale-8 for adherence assessment, pulmonary function test for evaluation of annual decline of forced expiratory volume in the first second, and the annual rate of exacerbations.

Results
The results obtained from visits 1 to 6 showed nonstatistically significant differences in forced expiratory volume in the first second (75 vs. 81.82 ml, P=0.820) and in adherence scale (Morisky Medication Adherence Scale-8) on visits 2–5 (40 vs. 17, P=0465), or the rate of exacerbation (two exacerbations in each group), with no statistically significant differences (0 vs. 13.3%, P=0.143) in group A and group B, respectively. On the contrary, the assessment of severity tools in ARST was based on the level of sustainability of the asthma stepwise categorization among the duration therapy. Using ARST for the aims of control and severity assessments on the studied group, in comparison with the GINA assessment approach, there were highly significant statistical differences in numbers of controlled patients as well as numbers of patients with mild and moderate asthma for severity assessments (t=13.263, P=0.001 vs. t=22.941, P=0.0001, respectively). It could be concluded that applying the GINA approach on studied group A revealed underestimation of control and probably overestimation of asthma severity, or better called asthma stability.

Conclusion
ARST is noninferior to the GINA approach in the norms of asthma control when objectivity was measured, whereas the levels of sustainability or stability among the duration therapy for assessment of asthma severity were statistically overestimated when measured by GINA. These measures could help most patients with asthma, and there should be a concerted action for their implementation in epidemiological research.