Background: Primary care physicians in Japan see many patients in a given day; consequently, they find it challenging to devote sufficient time for detailed clinical consultation and evaluation of asthma control status. The aim of this study was to investigate asthma symptoms that reveal the presence of inadequately controlled asthma. Methods: A pooled analysis of baseline data from 100 patients with asthma treated with inhaled corticosteroid(s) (ICS) alone or ICS/long-acting beta-agonist who participated in three previous clinical trials was performed. Asthma control status and asthmatic symptoms were determined using a five-item Asthma Control Questionnaire, and whether asthmatic symptoms reflect clinical markers was investigated. Results: Nocturnal awakening owing to asthmatic symptoms was observed only in the uncontrolled asthma group. Patient-reported wheezing was not observed in the group with well-controlled asthma, but was observed in all patients in the uncontrolled asthma group. Virtually all patients, irrespective of asthma control status, reported symptoms in the morning, limitation of normal daily activities, and shortness of breath. Conclusions: The presence of nocturnal awakening due to asthma and wheezing likely reflected uncontrolled asthma. These results will lead to re-recognition that clinical interview, querying nocturnal awakening from asthma and wheezing is a simple and useful approach to assess asthma control status in a primary care setting.
Ichinose, M., Sugiura, H., Nagase, H., Yamaguchi, M., Inoue, H., Sagara, H., et al. (2017) Japanese Guideline for Adult Asthma. Allergology International, 66, 163-189.
Demoly, P., Annunziata, K., Gubba, E. and Adamek, L. (2012) Repeated Cross-Sectional Survey of Patient-Reported Asthma Control in Europe in the Past 5 Years. European Respiratory Review, 21, 66-74.
Iwanaga, T., Kumar, M., Goren, A., Mukai, I. and Hattori, T. (2015) Cross Sectional Patient-Reported Survey on Asthma Control and Associated Burdens in Japanese Patients with Asthma in 2013. Therapeutic Research, 36, 235-246.
Hetlevik, O., Melbye, H. and Gjesdal, S. (2016) GP Utilisation by Education Level among Adults with COPD or Asthma: A Cross-Sectional Register-Based Study. NPJ Primary Care Respiratory Medicine, 26, 16027.
Juniper, E.F., O’Byrne, P.M., Guyatt, G.H., Ferrie, P.J. and King, D.R. (1999) Development and Validation of a Questionnaire to Measure Asthma Control. European Respiratory Journal, 14, 902-907.
Hozawa, S., Terada, M. and Hozawa, M. (2011) Comparison of Budesonide/Formoterol Turbuhaler with Fluticasone/Salmeterol Diskus for Treatment Effects on Small Airway Impairment and Airway Inflammation in Patients with Asthma. Pulmonary Pharmacology & Therapeutics, 24, 571-576.
Hozawa, S., Terada, M. and Hozawa, M. (2014) Comparison of the Effects of Budesonide/Formoterol Maintenance and Reliever Therapy with Fluticasone/Salmeterol Fixed-Dose Treatment on Airway Inflammation and Small Airway Impairment in Patients Who Need to Step-Up from Inhaled Corticosteroid Monotherapy. Pulmonary Pharmacology & Therapeutics, 27, 190-196.
Hozawa, S., Terada, M., Haruta, Y. and Hozawa, M. (2016) Comparison of Early Effects of Budesonide/Formoterol Maintenance and Reliever Therapy with Fluticasone Furoate/Vilanterol for Asthma Patients Requiring Step-Up from Inhaled Corticosteroid Monotherapy. Pulmonary Pharmacology & Therapeutics, 37, 15-23.
Matsunaga, K., Hirano, T., Oka, A., Ito, K. and Edakuni, N. (2016) Persistently High Exhaled Nitric Oxide and Loss of Lung Function in Controlled Asthma. Allergology International, 65, 266-271. https://doi.org/10.1016/j.alit.2015.12.006
Smolensky, M.H., Lemmer, B. and Reinberg, A.E. (2007) Chronobiology and Chronotherapy of Allergic Rhinitis and Bronchial Asthma. Advanced Drug Delivery Reviews, 59, 852-882. https://doi.org/10.1016/j.addr.2007.08.016
Kraft, M., Djukanovic, R., Wilson, S., Holgate, S.T. and Martin, R.J. (1996) Alveolar Tissue Inflammation in Asthma. American Journal of Respiratory and Critical Care Medicine, 154, 1505-1510. https://doi.org/10.1164/ajrccm.154.5.8912772
Siroux, V., Boudier, A., Anto, J.M., Cazzoletti, L., Accordini, S., Alonso, J., et al. (2008) Quality-of-Life and Asthma-Severity in General Population Asthmatics: Results of the ECRHS II Study. Allergy, 63, 547-554.
Jónsson, S., Kjartansson, G., Gíslason, D. and Helgason, H. (1988) Comparison of the Oral and Intravenous Routes for Treating Asthma with Methylprednisolone and Theophylline. Chest, 94, 723-726. https://doi.org/10.1378/chest.94.4.723
van der Wiel, E., Ten Hacken, N.H., Postma, D.S. and van den Berge, M. (2013) Small-Airways Dysfunction Associates with Respiratory Symptoms and Clinical Features of Asthma: A Systematic Review. Journal of Allergy and Clinical Immunology, 131, 646-657. https://doi.org/10.1016/j.jaci.2012.12.1567
Farah, C.S., King, G.G., Brown, N.J., Downie, S.R., Kermode, J.A., Hardaker, K.M., et al. (2012) The Role of the Small Airways in the Clinical Expression of Asthma in Adults. Journal of Allergy and Clinical Immunology, 129, 381-387.