A model to predict short-time asthma morbidity: what could be the explanatory factors?

  • Minoo Habibi Shaheed Labbafinezhad Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
  • Bersabeh Boroumand Clinical Pharmacy Department, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
  • Haleh Rezayee Clinical Pharmacy Department, School of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran.
  • Jamshid Salamzadeh Clinical Pharmacy Department, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Keywords: Asthma, Morbidity, Explanatory factors, Age, Systemic corticosteroid


Background: There is an increase in the worldwide prevalence, morbidity and mortality of asthma. Therefore, study of the possible factors related to the burden of this disorder could help the health providers to introduce effective initiatives and reduce adverse consequences due to this condition. This study was designed to investigate any relationship between asthma morbidity with inhaler technique and other probable explanatory factors in asthmatic patients.|
Methods: An observational, cross-sectional study was designed in which asthmatic patients referring to the outpatient respiratory clinic of the Shaheed Labbafinezhad hospital were entered the study using a non-probability sampling method. Their demographic, socio-economic, medical and medication history, inhaler technique (using a 10-step check list), as well as short-term morbidity index (in the past 4 weeks using the Jone’s morbidity questionnaire) were determined and recorded in organized data collection forms. These data were entered the Excel and SPSS (version 17.0) worksheets and analyzed using appropriate statistical tests. A step-by-step analysis method was used in order to find out any relationship between possible explanatory factors and the morbidity index of the patients.
Results: 199 adult asthmatic patients (94 male and 105 female) with mean ± SD age of 54.29 ± 15.52 years enrolled the study. In the first step of data analysis only 5 factors out of 20 explanatory factors were eligible to be included in the multivariate analysis leading to the final predictive model. In the multivariate regression analysis, 2 out of 5 factors could remain in the final model, which were “history of systemic steroid usage” and “age” (p=0.007, r=0.32). So that, patients with a positive history of systemic steroid use and those with a younger age had higher asthma morbidity rate.
Conclusion: The observed positive relationship between history of systemic steroid usage and asthma morbidity remarks the importance of asthma control in the primary care level and highlights its role on patient’s quality of life. Possible reasons leading to a higher morbidity rate in younger asthmatic patients should be evaluated in the future studies.


Global Strategy for Asthma Management and Prevention, Global Initiative for Asthma (GINA), (2010). Available from: URL: http://www.ginasthma.org/.

Braman SS. The Global Burden of Asthma. Chest 2006; 130; S 4–12.

Pawankar R, Baena-Cagnani CE, Bousquet J, et al. State of World Allergy Report 2008: Allergy and Chronic Respiratory Diseases.WAO Journal 2008; Supplement 1.

Coakley AL, Johnson AJ. Inhaled steroids for asthma. A qualitative study exploring patient’s views and the meeting of educational needs within inhaler packaging. J Asthma 1999; 4: 145-78.

O’callaghan C, Barry P. Delivering inhaled corticosteroids to patients: If side effects are important, why are we so ignorant of the dose inhaled? Br Med J 1999; 318: 410-11.

Clarck NM, Gong M. Management of chronic disease by practitioners and patients: Are we teaching the wrong things? Br Med J 2000; 320: 572-75.

Stevenson FA. The strategies used by general practitioners when providing information about medicines. Patient Education Counseling 2001; 43: 97- 104.

Wilson MA, Dempsey OJ, Coutie JRW, Sims EJ, Lipworth BJ. Importance of drug-device effects of inhaled corticosteroids. The Lancet 1999; 353: 21- 28.

Jones K, Cleary R, Hyland M. Predictive value of a simple asthma morbidity index in a general practice population. Br J Gen Pract 1999; 49: 23 -26.

University of Michigan Health System: Guidelines for clinical care, Asthma [on line], (Jan 2002),[accessed 9 July 2003]. Available from: URL: http:// http://www.med.umich.edu/prmc/media/newsroom.

Castro M, Schechtman KB, Halstead J, Bloomberg G. Risk factors for asthma morbidity and mortality in a large metropolitan city. J Asthma 2001; 38: 625-35.

Silvers SK, Lang DM. Asthma in African Americans: What can we do about the higher rates of disease? Cleveland Clin Med 2012; 7 9:193-201.

Altman DG. Practical statistics for medical research. Chapman and Hall, Boca Raton, 1999; 336-58.

American lung association Epidemiology and statistics unit: Trends in Asthma morbidity and Mortality [on line], July 2011. Available from URL: http://www.lungusa.org/finding-cures/our-research/trend-reports/asthma-trend-report.pdf.

Tsai CL, Delclos GL, Huang JS, Hanania NA, Camargo Jr. Age-related differences in asthma outcomes in the United States, 1988-2006. Ann Allergy Asthma Immunol 2013; 110: 240-46.

Amet JM. Asthma and environments: Do environmental factors affect the incidence and prognosis of asthma? Toxicology Letters 1995; 82 and 83: 33-38.

Li D, German D, Lulla S, Thomas RG, Wilson SR. Prospective study of hospitalization for asthma: A preliminary risk factor model. Am J Respir Crit Care Med 1995; 151:647-655.

Lieu TA, Quesenberry CP, Sorel ME, Mendoza GR, Leong AB. Computer – based models to identify high – risk children with asthma. Am J Respir Crit Care Med1998; 157: 1173 –80.

Rea HH, Garrett JE, Lanes SF, Birmann BM, Kolbe J. The association between asthma drugs and severe life – threatening attacks. Chest 1996; 110: 1446-51.

Perry TT, Rettiganti M, Brown RH Nick TG, Jones SM. Uncontrolled asthma and factors related to morbidity in an impoverished, rural environment. Ann Allergy Asthma Immunol 2012; 108:254–59.

Yuksel N, Ginter S, Man P, Tsuyuki RT. Underuse of inhaled corticosteroids in adults with asthma. Pharamacother 2000; 20: 387-93.

Salamzadeh J, Wong ICK, Hosker H, Chrystyn H. The relationship between the quality of prescribing and practice appointment rates with asthma management data in those admitted to hospital due to an acute exacerbation. Respiratory Med 2005; 99:735-41.

Moudgil H, Marshall T, Honeybourne D. Asthma education and quality of life in the community: a randomised controlled study to evaluate the impact on white European and Indian subcontinent ethnic groups from socioeconomically deprived areas in Birmingham, UK. Thorax 2000; 55:177–83.

Martys CR. Asthma care in Darley Dale: General practitioner audit. Br Med J 1992; 304: 758-60.

How to Cite
Habibi M, Boroumand B, Rezayee H, Salamzadeh J. A model to predict short-time asthma morbidity: what could be the explanatory factors?. J Pharm Care. 1(2):55-59.
Original Article(s)