An observational study to assess reasons for lack of control among patients of bronchial asthma attending a tertiary care centre in India


  • Ruchi Dua Department of Pulmonary Medicine, AIIMS, Rishikesh, Uttarakhand, India
  • Kashyap Goyal Department of Pulmonary Medicine, AIIMS, Rishikesh, Uttarakhand, India
  • Ritisha Bhatt Department of Pulmonary Medicine, AIIMS, Rishikesh, Uttarakhand, India
  • Krishna Singh Department of Pulmonary Medicine, AIIMS, Rishikesh, Uttarakhand, India
  • Navuluri Kranthi Kumar Reddy Department of Community and Family Medicine, AIIMS, Rishikesh, Uttarakhand, India
  • Prakhar Sharma Department of Pulmonary Medicine, AIIMS, Rishikesh, Uttarakhand, India



Adherence, Bronchial asthma, Depression, Level of control, Device technique of inhalational medication


Background: Bronchial asthma is a common chronic respiratory ailment affecting both children and adults. Lack of control among asthmatics leads to adverse outcomes and increased health care costs. Studies from India evaluating level of control and reasons for inadequate control are lacking. Objective was to assess level of control and reasons for partly/poorly controlled asthma.

Methods: Consecutive patients of bronchial asthma (>8 weeks on treatment) presenting to a tertiary care centre and consenting for participation in the study were enrolled. Control was assessed used global initiative for asthma (GINA) guidelines and patients categorised into poor, partly or well control.1 Enrolled patients were assessed by a questionnaire to record their demographic details including body mass index (BMI), duration of disease, smoking status, environmental smoke exposure/biomass fuel exposure, adherence to therapy, technique of inhaled medication and anxiety/depression, co morbidities including allergic rhinitis, gastro-oesophageal reflux (GER) symptoms, obstructive sleep apnoea (OSA) and allergic bronchopulmonary aspergillosis were also assessed.

Results: 150 consecutive patients, 58% females and 42% males with mean age of 40.03±14.77 years were enrolled. 19.3% of patients were well controlled while 50.7% were poorly and 30% were partly controlled. On comparing well controlled versus uncontrolled asthma (poor and partly controlled) adherence, device technique of inhaled medication, depression scores and eosinophilia showed a significant association. On application of logistic regression model, depression scores, inhaler adherence and device technique were associated with level of control.

Conclusions: Asthma is partly/poorly controlled in majority of asthmatics. Psychiatric co-morbidities, adherence to therapy and correct device technique are major reasons for partly/poorly controlled asthma. Addressing these modifiable factors can improve level of control among asthmatics.


Gina guidelines. Available at: https://ginasthma. org/wp-content/uploads/2019/06/GINA-2019-main-report-June-2019-wms.pdf. Accessed on 24 December 2021.

Snaith RP, Zigmond AS. The hospital anxiety and depression scale. Br Med J (Clin Res Ed). 1986;292(6516):344.

Chung F, Abdullah HR, Liao P. STOP-Bang Questionnaire: A Practical Approach to Screen for Obstructive Sleep Apnea. Chest. 2016;149(3):631-8.

Jindal SK, Aggarwal AN, Gupta D, Agarwal R, Kumar R, Kaur T, et al. Indian study on epidemiology of asthma, respiratory symptoms and chronic bronchitis in adults (INSEARCH). Int J Tuberc Lung Dis. 2012;16(9):1270-7.

Sundbom F, Malinovschi A, Lindberg E, Alving K, Janson C. Effects of poor asthma control, insomnia, anxiety and depression on quality of life in young asthmatics. J Asthma. 2016;53(4):398-403.

Awopeju OF, Salami OT, Oni OM, Adetiloye A, Kolawole T, Oyewo A, Erhabor GE. Comparing Asthma Control Test with Global Initiative for Asthma Defined Control in Nigerian Adult Asthmatics: A Prospective Cross-sectional study. West Afr J Med. 2019;36(1):29-42.

Fernández de Córdova-Aguirre JC , Velasco-Medina AA, Urquiza C, Guzmán-Guillén KA, Velázquez-Sámano G. Risk factors for uncontrolled asthma in adults. Rev Alerg Mex. 2019;66(1):65-75.

Haouichat H, Benali R, Benyounes A, Berrabah Y, Douagui H, Guermaz M, et al. Asthma control in adult Algerian patients. Comparison with other North African and Middle-East countries. Rev Mal Respir. 2020;37(1):15-25.

Al-Jahdali H, Wali S, Salem G. Asthma control and predictive factors among adults in Saudi Arabia: Results from the Epidemiological Study on the Management of Asthma in Asthmatic Middle East Adult Population study. Ann Thorac Med. 2019;14(2):148-54.

Cazzoletti L, Marcon A, Janson C. Therapy and Health Economics Group of the European Community Respiratory Health Survey. Asthma control in Europe: a real-world evaluation based on an international population-based study. J Allergy Clin Immunol. 2007;120:1360-7.

Gold LS, Thompson P, Salvi S, Faruqi RA, Sullivan SD. Level of asthma control and health care utilization in Asia-Pacific countries. Respir Med. 2014;108(2):271-7.

Dursun AB, Kurt OK, Bayiz H, Ozkan E, Cakaloglu A, Karasoy D. Does gender affect asthma control in adult asthmatics? Chron Respir Dis. 2014;11:83-7.

Forte GC, Hennemann ML, Dalcin PTR. Asthma control, lung function, nutritional status, and health-related quality of life: differences between adult males and females with asthma. J Bras Pneumol. 2018;44(4):273-8.

Chhabra SK, Chhabra P. Gender differences in perception of dyspnea, assessment of control, and quality of life in asthma. J Asthma. 2011;48(6):609-15.

Gebremariam TH, Binegdie AB, Mitiku AS. Level of asthma control and risk factors for poor asthma control among clinic patients seen at a Referral Hospital in Addis Ababa, Ethiopia. BMC Res Notes. 2017;10(1):558.

Baddar S, Jayakrishnan B, Al-Rawas OA. Asthma control: importance of compliance and inhaler device technique assessments. J Asthma. 2014;51(4):429-34.

Mothae TW, Mosweu G, Thinyane KH, Mohlabula TV. Assessment of asthma control in primary care in Maseru, Lesotho. Afr J Respir Med. 2016;12(1):11.

Chogtu B, Holla S, Magazine R, Kamath A. Evaluation of relationship of inhaler device technique with asthma control and quality of life. Indian J Pharmacol. 2017;49(1):110-5.

Roman-Lay A. Association of asthma control with psychological factors in women. Rev Med Chil. 2018;146(3):323-30.

Misra S, Kundu S, Majumder D, Kundu S, Ghoshal AG, Mitra R. A Study of Depression in Adult Patients with Bronchial Asthma Presenting to a Tertiary Care Hospital in Eastern India. Indian J Chest Dis Allied Sci. 2015;57(2):87-90.




How to Cite

Dua, R., Goyal, K., Bhatt, R., Singh, K., Reddy, N. K. K., & Sharma, P. (2022). An observational study to assess reasons for lack of control among patients of bronchial asthma attending a tertiary care centre in India. International Journal Of Community Medicine And Public Health, 9(4), 1782–1787.



Original Research Articles