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Reconcilable Differences: Conclusions

Published in Asthma

An assumption of this analysis is that the excessive use of SA P-agonists is synonymous with asthma control, an assumption that is supported by both the metrics of control included in the current asthma management guidelines and the Asthma Control Questionnaire, and expert opinion. These results are also dependent on the measurement and adjustment for asthma severity. The quantification of severity is complicated by the complex relationship between asthma severity and asthma control, and thus many of attributes deemed explanatory of asthma severity (eg, symptoms, pulmonary function, and morbidity) are also representative of asthma control. Although we agree with Cockroft and Swystyn that ideally asthma severity should be quantified based on the magnitude of treatment required to control symptoms, this was not possible due to the cross-sectional nature of our study. Therefore, it was necessary for us to adjust for asthma severity based on all proposed dimensions of asthma severity including symptoms, pulmonary function, morbidity, and controller medication use. Therefore, the only variable that can truly be used to quantify asthma control in this population is the magnitude of short-acting P agonist use. If adequately controlled, only the most severe, treatment recalcitrant asthmatics should be using more than four doses of short-acting P agonist per week independent of asthma severity. No participant in this study could be considered treatment resistant, and therefore short-acting P agonist use is a valid measure of treatment control in all study participants.

Because there is currently no “gold standard” for measuring asthma severity, we applied five different methods of controlling for asthma severity, and each model included additional measures of any proposed dimension of asthma severity not included in the score. This maximized the variance of SA P-agonist explained by all dimensions of severity prior to adding SES to the model. The consistency of this approach with the theoretical framework of quantifying asthma severity, of the results across all methods of severity adjustment, and the presence of a gradient across income and education strengthen our conclusions. my canadian pharmacy
These results and our previous analysis support our hypothesis of a social gradient in asthma control, independent of asthma severity. This consequentially leads to the hypothesis that improving asthma management in lower social classes may result in a narrowing of the gap in asthma-related outcomes. The determination of the SES-related etiologic factors of inadequate asthma management, such as health beliefs, health behaviors, self-esteem, motivation, knowledge, economic barriers, and medical system management, will be the next step in developing programs and strategies to reduce the social gradient in asthma-related outcomes.