Selected sociodemographic and drug adherence factors associated with uncontrolled asthma at chest clinic, Kenyatta National Hospital

Abstract

Background: Factors influencing asthma control include patient adherence with prescribed medications and sociodemographic characteristics. The prevalence of uncontrolled asthma and factors that affect asthma control have not been explored at Kenyatta National Hospital (KNH). Study Objectives: To determine the level of asthma control in adults at KNH chest clinic and determine selected sociodemographic and drug adherence factors associated with the level (s) of control achieved. Study Design: A descriptive cross-sectional study. Study site: KNH Chest Clinic. Patients: Asthmatic patients aged more than 13 years, on follow up for asthma for more than 6 months prior to study commencement. Materials and Methods: Patients' clinical data, asthma control and treatment modalities data were collected using a standard validated Asthma Control Questionnaire and a proforma. Primary outcome: A composite value of the rates and profile of subjects with either well- . controlled or poorly controlled asthma. Secondary outcomes: The factors associated with either well-controlled or poorly controlled asthma among the study subjects and the drug treatment modalities used for asthma control. Data analysis: Was done using SPSS version 16.0. Qualitative variables were summarized with numbers and frequency distributions. Quantitative variables were summarized with means, standard error, median, minimum and maximum. A multivariate analysis was performed (logistic regression including the following factors in the model: age, sex, education level, asthma control. drug adherence status, and number of drugs at inclusion. Results: Three hundred and sixty asthma patients with a mean age of 44.9 years (17.7 years SD); ranging from 13 to 100 years. Majority were female (75.3%) and with secondary level of education (39.2%). Most patients were uncontrolled for their disease (64.7%) and there were no statistically significant differences between the socio-demographic characteristics (sex, age and educational level) and asthma control. Eighty five point eight percent (85.8%) of the patients were adherent to the drugs prescribed and patients that did not adhere to the prescribed medications cited lack of money (83.7%) and forgetfulness (67.4%) as the commonest reasons for their non-adherence. The commonest drug used was inhalational corticosteroid (budesonide) (94.7%) followed by short-acting B2-agonist inhaler (92.5%). A greater part of the patients were on combination therapies of 2 (58.5%) and 3 (25.8%) drugs with the commonest drug combinations being inhalational corticosteroid with short-acting B2 -agonist. Patient adherence to the treatments given and the number of drug combination regimens the patient was taking were the key determinants of overall asthma control on this clinic (p-value=0.004 and 0.005 respectively). Conclusion: Most patients with asthma at KNH chest clinic were uncontrolled. Majority of the sufferers who were uncontrolled were aged between 30-60 years and more likely to use multiple drugs (combination therapy of two or three drugs). More than 84% of them were adherent to their drugs. The two chief predictors of poor asthma control were the number of drugs the individual patient was taking and the drug adherence status .