Ana Carla Sousa de Araujo, Érica Ferraz, Marcos de Carvalho Borges,
João Terra Filho, Elcio Oliveira Vianna
Objective: To determine the prevalence of factors associated with difficult-to-control asthma. Methods: Patients with severe asthma
were selected from the outpatient asthma clinic of the Ribeirão Preto School of Medicine Hospital das Clínicas. The patients were divided
into two groups: controlled severe asthma and difficult-to-control severe asthma. After new attempts to optimize the severe asthma
treatment, a questionnaire was applied, and additional tests for factors associated with difficult-to-control asthma, such as environmental
and occupational exposure, smoking history, social factors, rhinitis/sinusitis, gastroesophageal reflux disease (GERD), obstructive sleep apnea,
congestive heart failure (CHF), pulmonary embolism, cystic fibrosis, vocal cord dysfunction, α-1 antitrypsin deficiency, and Churg-Strauss
syndrome, were performed. Results: 77 patients with severe asthma were selected, of which 47 suffered from hard-to-control asthma,
being 68.1% female, with mean age of 44.4 years (±14.4), and forced expiratory volume in one second of 54.7% (±18.3). The most factors
most often associated with difficult-to-control asthma were noncompliance with treatment (68%), rhinitis/sinusitis (57%), GERD (49%),
environmental exposure (34%), occupational exposure (17%), smoking history (10%), obstructive sleep apnea (2%), and CHF (2%). At least
one of these factors was identified in every case. Conclusions: Noncompliance with treatment was the factor most often associated with
difficult-to-control asthma, underscoring the need to investigate comorbidities in the evaluation of patients with this form of the disease.
Keywords: Asthma; Smoking; Gastroesophageal reflux; Patient compliance; Rhinitis; Sinusitis.