J Clin Med Res

Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Clin Med Res and Elmer Press Inc

Journal website http://www.jocmr.org

Original Article

Volume 12, Number 6, June 2020, pages 362-368

Outpatient Management of Bronchial Asthma: A Comparative Analysis Between Guideline-Directed Management and Usual Management

**Table 1.** Demographics and Clinical Characteristics
Variable	Guideline-directed medical therapy (n = 139)	Usual medical therapy (n = 161)	P
^aIndependent t-test; ^bChi-square and Fisher’s exact test. NS: not significant; BMI: body mass index; SD: standard deviation.
Age (years), mean (SD)	56.7 (15.6)	56.7 (15.8)	0.986^a
Gender
Male (n, %)	40 (28.8)	45 (28)	0.874^b
Female (n, %)	99 (71.2)	116 (72)	0.874^b
Race			0.796^b
White (n, %)	88 (63.3)	107 (66.5)
Black (n, %)	24 (17.3)	22 (13.7)
Hispanic (n, %)	21 (15.1)	23 (14.3)
Asian (n, %)	6 (4.3)	9 (5.6)
Social factor, cigarette smoking (n, %)	52 (37.4)	71 (44.1)	0.240^b
BMI (kg/m²), mean (SD)	32.1 (8.3)	31.6 (7.2)	0.635^a
Asthma severity			0.394^b
Mild (n, %)	131 (94.2)	155 (96.3)
Moderate (n, %)	8 (5.8)	5 (3.1)
Severe (n, %)	0 (0.0)	1 (0.6)

Table 1. Demographics and Clinical Characteristics

Variable

Guideline-directed medical therapy (n = 139)

Usual medical therapy (n = 161)

^aIndependent t-test; ^bChi-square and Fisher’s exact test. NS: not significant; BMI: body mass index; SD: standard deviation.

Age (years), mean (SD)

56.7 (15.6)

56.7 (15.8)

0.986^a

Gender

Male (n, %)

40 (28.8)

45 (28)

0.874^b

Female (n, %)

99 (71.2)

116 (72)

0.874^b

Race

0.796^b

White (n, %)

88 (63.3)

107 (66.5)

Black (n, %)

24 (17.3)

22 (13.7)

Hispanic (n, %)

21 (15.1)

23 (14.3)

Asian (n, %)

6 (4.3)

9 (5.6)

Social factor, cigarette smoking (n, %)

52 (37.4)

71 (44.1)

0.240^b

BMI (kg/m²), mean (SD)

32.1 (8.3)

31.6 (7.2)

0.635^a

Asthma severity

0.394^b

Mild (n, %)

131 (94.2)

155 (96.3)

Moderate (n, %)

8 (5.8)

5 (3.1)

Severe (n, %)

0 (0.0)

1 (0.6)

**Table 2.** Associated Comorbid Conditions
Variable	Guideline-directed medical therapy (n = 139)	Usual medical therapy (n = 161)	P^a
^aChi-square and Fisher’s exact test. CHF: congestive heart failure; ESRD: end-stage renal disease; ESLD: end-stage liver disease; GERD: gastroesophageal reflux disorder; COPD: chronic obstructive pulmonary disease.
CHF (n, %)	14 (10.1)	16 (9.9)	0.969
ESRD (n, %)	1 (0.7)	0 (0.0)	0.463
ESLD (n, %)	3 (2.2)	2 (1.2)	0.537
Anemia (n, %)	22 (15.8)	27 (16.8)	0.826
Rheumatoid arthritis (n, %)	5 (3.6)	10 (6.2)	0.300
Multisystem rheumatic disorder (n, %)	12 (8.6)	9 (5.6)	0.303
Psychiatric diseases (n, %)	50 (36.0)	82 (50.9)	0.650
GERD (n, %)	61 (43.9)	75 (46.6)	0.640
COPD (n, %)	11 (7.9)	19 (11.8)	0.263
Allergic rhinitis (n, %)	52 (5.8)	63 (39.1)	0.760
Atopic dermatitis (n, %)	8 (17.6)	14 (8.7)	0.330
Nasal polyp (n, %)	1 (0.7)	1 (0.6)	1.000
Eosinophilia (n, %)	10 (8.6)	12 (9.0)	0.926

Table 2. Associated Comorbid Conditions

Variable

Guideline-directed medical therapy (n = 139)

Usual medical therapy (n = 161)

P^a

^aChi-square and Fisher’s exact test. CHF: congestive heart failure; ESRD: end-stage renal disease; ESLD: end-stage liver disease; GERD: gastroesophageal reflux disorder; COPD: chronic obstructive pulmonary disease.

CHF (n, %)

14 (10.1)

16 (9.9)

0.969

ESRD (n, %)

1 (0.7)

0 (0.0)

0.463

ESLD (n, %)

3 (2.2)

2 (1.2)

0.537

Anemia (n, %)

22 (15.8)

27 (16.8)

0.826

Rheumatoid arthritis (n, %)

5 (3.6)

10 (6.2)

0.300

Multisystem rheumatic disorder (n, %)

12 (8.6)

9 (5.6)

0.303

Psychiatric diseases (n, %)

50 (36.0)

82 (50.9)

0.650

GERD (n, %)

61 (43.9)

75 (46.6)

0.640

COPD (n, %)

11 (7.9)

19 (11.8)

0.263

Allergic rhinitis (n, %)

52 (5.8)

63 (39.1)

0.760

Atopic dermatitis (n, %)

8 (17.6)

14 (8.7)

0.330

Nasal polyp (n, %)

1 (0.7)

1 (0.6)

1.000

Eosinophilia (n, %)

10 (8.6)

12 (9.0)

0.926

**Table 3.** Comorbidities and Relation to Exacerbations
Variable	Odds ratio^a	95% confidence interval odds ratio
^aLogistic regression. BMI: body mass index; COPD: chronic obstructive pulmonary disease; CHF: congestive heart failure; ESLD: end-stage liver disease; GERD: gastroesophageal reflux disorder.
Age	1.02	0.99	1.04
Race
Caucasian vs. black	1.06	0.46	2.44
Caucasian vs. Hispanic	0.93	0.38	2.25
Caucasian vs. Asian	1.99	0.50	7.94
BMI	1.03	0.99	1.07
COPD overlap	2.755	0.80	9.45
CHF	4.34	1.25	15.01
ESLD	0.17	0.01	3.78
Rheumatoid arthritis	0.86	0.21	3.56
Multisystem disease	1.24	0.35	4.43
Psychiatric disease	0.87	0.45	1.65
GERD	0.92	0.48	1.78
Asthma severity	9.72	4.83	19.60
Smoking history	1.48	0.79	2.79
Allergic rhinitis	2.04	1.03	4.03
Atopic dermatitis	1.10	0.24	4.99
Nasal polyps	1.71	0.09	33.20
Eosinophilia	0.60	0.18	2.00

Table 3. Comorbidities and Relation to Exacerbations

Variable

Odds ratio^a

95% confidence interval odds ratio

Lower

Upper

^aLogistic regression. BMI: body mass index; COPD: chronic obstructive pulmonary disease; CHF: congestive heart failure; ESLD: end-stage liver disease; GERD: gastroesophageal reflux disorder.

Age

1.02

0.99

1.04

Race

Caucasian vs. black

1.06

0.46

2.44

Caucasian vs. Hispanic

0.93

0.38

2.25

Caucasian vs. Asian

1.99

0.50

7.94

BMI

1.03

0.99

1.07

COPD overlap

2.755

0.80

9.45

CHF

4.34

1.25

15.01

ESLD

0.17

0.01

3.78

Rheumatoid arthritis

0.86

0.21

3.56

Multisystem disease

1.24

0.35

4.43

Psychiatric disease

0.87

0.45

1.65

GERD

0.92

0.48

1.78

Asthma severity

9.72

4.83

19.60

Smoking history

1.48

0.79

2.79

Allergic rhinitis

2.04

1.03

4.03

Atopic dermatitis

1.10

0.24

4.99

Nasal polyps

1.71

0.09

33.20

Eosinophilia

0.60

0.18

2.00

**Table 4.** Medications Prescribed
Medication	Guideline-directed medical therapy (n = 139)	Usual medical therapy (n = 161)	P^a
^aChi-square and Fisher’s exact test.
Short-acting beta agonist (n, %)	138 (99.3)	83 (51.6)	< 0.001
Inhaled corticosteroid (n, %)	69 (49.6)	54 (33.5)	0.005
Low (n, %)	15 (10.8)	19 (11.8)
Medium (n, %)	27 (19.4)	22 (13.7)
High (n, %)	27 (19.4)	13 (8.1)
Long-acting beta agonist (n, %)	48 (34.5)	34 (21.1)	0.009
Long-acting muscarinic antagonist (n, %)	3 (2.2)	16 (9.9)	0.006
Leukotriene inhibitor (n, %)	23 (16.5)	61 (37.9)	< 0.001
Omalizumab (n, %)	2 (1.4)	0 (0.0)	0.214

Table 4. Medications Prescribed

Medication

Guideline-directed medical therapy (n = 139)

Usual medical therapy (n = 161)

P^a

^aChi-square and Fisher’s exact test.

Short-acting beta agonist (n, %)

138 (99.3)

83 (51.6)

< 0.001

Inhaled corticosteroid (n, %)

69 (49.6)

54 (33.5)

0.005

Low (n, %)

15 (10.8)

19 (11.8)

Medium (n, %)

27 (19.4)

22 (13.7)

High (n, %)

27 (19.4)

13 (8.1)

Long-acting beta agonist (n, %)

48 (34.5)

34 (21.1)

0.009

Long-acting muscarinic antagonist (n, %)

3 (2.2)

16 (9.9)

0.006

Leukotriene inhibitor (n, %)

23 (16.5)

61 (37.9)

< 0.001

Omalizumab (n, %)

2 (1.4)

0 (0.0)

0.214

**Table 5.** Exacerbations and Hospitalizations
Patient outcome	Guideline-directed medical therapy (n = 139)	Usual medical therapy (n = 161)	P^a
aa ^aIndependent t-test.
Number of exacerbations			0.034
0 (n, %)	72 (51.8)	109 (67.7)
1 (n, %)	61 (43.9)	47 (29.2)
2 (n, %)	5 (3.6)	3 (1.9)
3 (n, %)	1 (0.7)	2 (1.2)
Number of hospitalizations			0.349
0 (n, %)	131 (94.2)	155 (96.3)
1 (n, %)	8 (5.8)	5 (3.1)
2 (n, %)	0 (0.0)	1 (0.6)

Table 5. Exacerbations and Hospitalizations

Patient outcome

Guideline-directed medical therapy (n = 139)

Usual medical therapy (n = 161)

P^a

aa ^aIndependent t-test.

Number of exacerbations

0.034

0 (n, %)

72 (51.8)

109 (67.7)

1 (n, %)

61 (43.9)

47 (29.2)

2 (n, %)

5 (3.6)

3 (1.9)

3 (n, %)

1 (0.7)

2 (1.2)

Number of hospitalizations

0.349

0 (n, %)

131 (94.2)

155 (96.3)

1 (n, %)

8 (5.8)

5 (3.1)

2 (n, %)

0 (0.0)

1 (0.6)