Factors Influencing Disease Control in Patients with Asthma

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Saisunee Arpibanwana
Doungrut Wattanakitkrileart
Kanaungnit Pongthavornkamol
Wanchai Dejsomritrutai


Purpose: This research aimed to study the influences of depression, adherence to inhaled corticosteroids, smoking and comorbidity on disease control in patients with asthma.

Design: Correlational predictive research.

Methods: The subjects comprised 130 patients aged 18 years and older with asthma who received inhaled corticosteroids at least 3 months and came for follow-up visits at the Asthma Clinic of one tertiary hospital in Bangkok, Thailand. The subjects were recruited by conveniene sampling. Data were collected by questionnaires on demography, the Level of Asthma Control according to Global Initiative for Asthma (GINA) criteria, the Center for Epidemiological Studies Depression Scale, the Medication Adherence Report Scale and the Charlson Comorbidity Index. Data were analyzed using descriptive statistics and enter method logistic regression analysis. 

Main findings: Two-thirds of the subjects were females (66.6%) with a mean age of 63 years (SD = 12.7). More than half (54.6%) had uncontrolled asthma. Fourteen percent had developed depression. The subjects (54.6%) had adherence to inhaled corticosteroids. One-fourths (25.4%) were smokers. Most of the subjects (93.8%) had comorbidities and almost half (47.7%) had a low level of comorbidities. Depression, adherence to inhaled corticosteroids, smoking, and comorbidity were able to predict disease control in patients with asthma at 21.4 percent (Nagelkerke R2 = .214). Depression and adherence to inhaled corticosteroids were able to predict with statistical significance (OR = 19.13, 95%CI = 2.37, 154.64 and OR = 2.21, 95%CI = 1.03, 4.78, respectively).

Conclusion and recommendations: Depression and adherence to inhaled corticosteroids were manageable factors could affect with asthma control. Nurses and healthcare teams should pay attention to assessing depression and adherence to inhaled corticosteroids in order to prevent or manage depression and development of a nursing care program for increasing adherence to inhaled corticosteroids, which can lead to improved disease control in patients with asthma.

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How to Cite
Arpibanwana, S., Wattanakitkrileart, D., Pongthavornkamol, K., & Dejsomritrutai, W. (2018). Factors Influencing Disease Control in Patients with Asthma. Nursing Science Journal of Thailand, 36(4), 39–51. Retrieved from https://he02.tci-thaijo.org/index.php/ns/article/view/176893
Research Papers


1. World Health Organization. Chronic respiratory disease: fact sheet in asthma [Internet]. Geneva, Switzerland: World Health Organization; 2017 [cited 2017 May 30]. Available from: http://www.who.int/mediacentre/factsheets/fs307/en/
2. Bureau of Policy and Strategy, Office of the Permanent Secretary, Ministry of Public Health. Public health statistics A.D. 2015 [Internet]. Bangkok: Bureau of Policy and Strategy; 2015 [cited 2017 May 1]. Available from: http://bps.moph.go.th/new_bps/
sites/default/files/health_statistic2558.pdf. (in Thai).
3. Global Initiative for Asthma. Global strategy for asthma management and prevention [Internet]. USA: Global Initiative for Asthma; 2017 [cited 2017 Jun 2]. Available from: https://www.slideshare.net/UtaiSukviwatsirikul/2017-gina-report-globalstrategy-
4. Thai Asthma Council, Thoracic Society of Thailand under Royal Patronage, The Allergy, Asthma, and Immunology Association of Thailand, The Royal College of Family Physicians of Thailand. Thai asthma guideline for adults. [Internet]. Bangkok: Thai Asthma Council; 2017 [cited 2017 May 20]. Available from: http://tac.or.th/wp-content/uploads/2017/05/Asthma-Guideline_2560.pdf. (in Thai).
5. Al-Zahrani JM, Ahmad A, AL-Harb A, Khan AM, Al-Bader B, Baharoon S, et al. Factors associated with poor asthma control in the outpatient clinic setting. Ann Thorac Med. 2015;10(2):100-4.
6. Tripopsakul W. Factors Associated with Poor Controlled Asthma in Lerdsin Hospital. Journal of the Department of Medical Services. 2016;41(5):67-74. (in Thai).
7. Casciano J, Krishnan J, Small MB, Li C, Dotiwala Z, Martin BC. Progression to uncontrolled severe asthma: a novel risk equation. J Manag Care Spec Pharm. 2017;23(1):44-50.
8. Tay TR, Radhakrishna N, Hore-Lacy F, Smith C, Hoy R, Dabscheck E, et al. Comorbidities in difficult asthma are independent risk factors for frequent exacerbations, poor control and diminished quality of life. Respirology. 2016;21(8):1384-90.
9. Vervloet D, Pribil C, Dumur JP, Godard P, Salmeron S, Serrier P, et al. Factors associated with poorly controlled asthma among adults in France. Rev Fr Allergol. 2014;54(6):428-37.
10. Kapadia SG, Wei C, Bartlett SJ, Lang J, Wise RA, Dixon AE, et al. Obesity and symptoms of depression contribute independently to the poor asthma control of obesity. Respir Med. 2014;108(8):1100-7.
11. Rifaat N, Abdel-Hady E, Hasan AA. The golden factor in adherence to inhaled corticosteroid in asthma patients. Egypt J Chest Dis Tuberc. 2013;62(3):371-6.
12. Yan BD, Meng SS, Ren J, Lv Z, Zhang QH, Yu JY, et al. Asthma control and severe exacerbations in patients with moderate or severe asthma in Jilin Province, China: a multicenter cross-sectional survey. BMC Pulm Med. 2016;16(1):130. doi: 10.1186/s12890-016-0292-3. PubMed PMID: 27577233; PubMed Central PMCID: PMC5006269.
13. Roy SC. The Roy adaptation model. 3rd ed. New Jersey: Pearson; 2008.
14. Faul F, Erdfelder E, Lang AG, Buchner A. G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods. 2007;39(2):175-91.
15. Brodaty H, Pond D, Kemp NM, Luscombe G, Harding L, Berman K, et al. The GPCOG: a new screening test for dementia designed for general practice. J Am Geriatr Soc. 2002;50(3):530-4.
16. Griffiths J, Putthioi S, Pongsuksri M. The General Practitioner Assessment of Cognition; GP-COG (Thai version): validity and reliability. In: 9th Pan-Pacific Conference on Rehabilitation cum 21st Annual Congress of Gerontology; 2014 November 29-30; Hong Kong. Kowloon: The Hong Kong Polytechnic University; [2014]. p.B65. (in Thai).
17. Radloff LS. The CES-D scale: a self-report depression scale for research in the general population. Appl Psychol Meas. 1977;1(3):385-401.
18. Kuptniratsaikul V, Pekuman P. The study of the Center for Epidemiologic Studies-Depression scale (CES-D) in Thai people. Siriraj Medical Journal. 1997;49(5):442-8. (in Thai).
19. Horne R, Hankins M. The medication adherence report scale. Brighton, England: Center for Health Care Research; 2002.
20. Khamrag C, Wattanakitkrilert D, Charoenkitkarn V, Dejsomritrutai W. Influences of perceived medication necessity, medication concern, side effects, and treatment-time on inhaled corticosteroids adherence in adult patients with asthma. Journal of Nursing Science. 2016;34(1):73-82. (in Thai).
21. Charlson ME, Charlson RE, Petersona JC, Marinopoulos SS, Briggs WM, Hollenberg JP. The Charlson comorbidity index is adapted to predict costs of chronic disease in primary care patients. J Clin Epidemiol. 2008;61(12):1234-40.
22. Putkong S, Panpakdee O, Malathum P, Kawamatawong T. Factors related to self-care behavior for medication use and perceived asthma control in older persons with asthma. Ramthibodi Nursing Journal. 2011;17(3):309-26. (in Thai).
23. Office of Air Quality and Noise Management Bureau, Pollution Control Department. Air pollution in Bangkok: real-time air quality index [Internet]. Bangkok: Office of Air Quality and Noise Management Bureau; 2018 [cited 2018 Jun 4]. Available from: http://air4thai.pcd.go.th/webV2/download.php. (in Thai).
24. Sangsawang N, Sangsawang B. Depression in adults asthmatic patients: pathophysiology, impacts, related factors, and nursing care. Journal of Medicine and Health Sciences. 2015;22(2):61-70. (in Thai).
25. Campos FL, de Bruin PFC, Pinto TF, da Silva FGC, Pereira EDB, Bruin de VMS. Depressive symptoms, quality of sleep, and disease control in women with asthma. Sleep Breath. 2017;21(2):361-7.
26. Sirimai P. Inhaled corticosteroids use patterns and patient outcomes in asthmatic patients. Thai Journal of Tuberculosis Chest Disease and Critical Care. 2012;33(2):43-9. (in Thai).
27. Charmphunot R. Smoking effects to respiratory system. In: Rungruanghiranya S, Kongsakon R, editors. Toxicity & management of tobacco dependence. Bangkok: Sahaprachapanit; 2009. p.158-62. (in Thai).