Identification of clusters of asthma control: A preliminary analysis of the inspirers studies

Cristina Jácome, Rita Amaral, Rute Almeida, Ana Margarida Pereira, Mariana Couto, Luís Araújo, Magna Alves-Correia, Mariana Pereira, Manuel Ferreira-Magalhães, Cláudia Chaves Loureiro, Maria Joana Catarata, Lília Maia Santos, Sara Cabral, João Pereira, Bárbara Ramos, Cristina Lopes, Ana Mendes, Anabela Lopes, José Carlos Cidrais Rodrigues, Georgeta OliveiraAna Paula Aguiar, Ivete Afonso, Joana Carvalho, Ana Maria Arrobas, José Costa, Margarida Valério, Marta Pereira, Teresa Almeida, Joana Dias, Ana Todo Bom, João Azevedo, Carmelita Ribeiro, Marta Alves, Paula Leiria Pinto, Nuno Neuparth, Ana Castro Neves, Ana Palhinha, João Gaspar Marques, Pedro Martins, David Pina Trincão, Filipa Todo Bom, Maria Alvarenga Santos, Joana Branco, Alberto Costa, Armandina Silva Neto, Marta Santalha, Carlos Lozoya, Natacha Santos, Diana Silva, Maria João Vasconcelos, Luís Taborda Barata, Maria Fernanda Teixeira, Diana Pinto, Rodrigo Rodrigues Alves, Ana Sofia Moreira, Cláudia Sofia Pinto, Pedro Morais Silva, Carlos Alves, Raquel Câmara, Didina Coelho, Diana Bordalo, Fernanda Carvalho, Ricardo Fernandes, Rosário Ferreira, José Ferraz de Oliveira, Fernando Menezes, Ricardo Gomes, Maria José Calix, Ana Marques, João Cardoso, Madalena Emiliano, Rita Gerardo, Carlos Nunes, José Alberto Ferreira, Inês Lopes, Adelaide Alves, João Almeida Fonseca

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© 2020, Sociedade Portuguesa de Alergologia e Imunologia Clinica. All rights reserved. Aims: To identify distinct asthma control clusters based on Control of Allergic Rhinitis and Asthma Test (CARAT) and to compare patients’ characteristics among these clusters. Methods: Adults and adolescents (≥13 years) with persistent asthma were recruited at 29 Portuguese hospital outpatient clinics, in the context of two observational studies of the INSPIRERS project. Demographic and clinical characteristics, adherence to inhaled medication, beliefs about inhaled medication, anxiety and depression, quality of life, and asthma control (CARAT, >24 good control) were collected. Hierarchical cluster analysis was performed using CARAT total score (CARAT-T). Results: 410 patients (68% adults), with a median (percentile 25–percentile 75) age of 28 (16-46) years, were analysed. Three clusters were identified [mean CARAT-T (min-max)]: cluster 1 [27(24-30)], cluster 2 [19(14-23)] and cluster 3 [10(2-13)]. Patients in cluster 1 (34%) were characterised by better asthma control, better quality of life, higher inhaler adherence and use of a single inhaler. Patients in clusters 2 (50%) and 3 (16%) had uncontrolled asthma, lower inhaler adherence, more symptoms of anxiety and depression and more than half had at least one exacerbation in the previous year. Further-more, patients in cluster 3 were predominantly female, had more unscheduled medical visits and more anxiety symp-toms, perceived a higher necessity of their prescribed inhalers but also higher levels of concern about taking these inhalers. There were no differences in age, body mass index, lung function, smoking status, hospital admissions or specialist physician follow-up time among the three clusters. Conclusion: An unsupervised method based on CARAT--T, identified 3 clusters of patients with distinct, clinically meaningful characteristics. The cluster with better asthma control had a cut-off similar to the established in the validation study of CARAT and an additional cut-off seems to distinguish more severe disease. Further research is necessary to validate the asthma control clusters identified.
Original languageEnglish
Pages (from-to)231-240
Number of pages10
JournalRevista Portuguesa de Imunoalergologia
Issue number4
Publication statusPublished - 2020


  • Asthma
  • Asthma control
  • Classification
  • Cluster analysis
  • Control of allergic rhinitis and asthma test


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