922
KLINICKÁ341804301074588109168189242288347
FARMAKOLOGIE708804301074392139212266313373416475534555599
A13288043010753
FARMACIE1402804301074292139211266317337381
/18048043010757
Klin1880804301077091109157
Farmakol2057804301074278105179220258305325
Farm2402804301074178104179
2019;2601804301074386126164180
33(3):2801804301074385107150171185
11–163006804301074478120159198
/32238043010757
www.klinickafarmakologie.cz4568804301076513320121425327329234035839843647950254457164568672477179183988990895196610061045
141888026012657110
ORIGINÁLNÍ341207012673138172244278352422476549582
PRÁCE945207012660124196256314
Targeting34136501063066101141173206224265304
asthma66136501063872104146200240
control91736501063271113145181222253
in118536501061657
real‑life125836501063365107138160191208239271
clinical15453650106326381122140174216247
practice180836501063268109143176194229261
by208436501063470
using21703650106397188129168
ICS/LABA23533650106165185111142184219259
combination262836501063271125161179220260288306346388
Limitation340255501435479176201238293329354418482
in850255501432690
daily9692555014365119144169222
activities12182555014356110150175230255293318376420
A4802723010753
similar552272301073755129147166206233
trend805272301073057100148198
was10252723010765107140
observed1188272301074898131176202246289339
for1547272301072774101
limitation1668272301072240114132160202229248296344
in340286301071965
the425286301072471114
patients’555286301074990116134177224250284300
daily870286301074988106125164
activities.1049286301074180110128168187214233276308325
The1389286301074290134
proportion1538286301074976122171219245275294341388
of1942286301074771
patients340300301075091118137181229256291
with651300301076585113161
a8323003010741
limitation893300301072039112131159200227246294343
in1255300301072068
daily1343300301074990109127167
activities1530300301074282113132173192220239283316
gradually1867300301074975117340314301074996137156175215
decreased574314301074993134161204244277321372
from96531430107245198173
67%1157314301074485151
at1328314301074168
the1415314301072876121
baseline1555314301075091125169188207254299
visit187331430107416093111139
to340328301072874
5%4313283010744108
at556328301074168
the644328301072473117
end777328301074492141
of935328301074872
the1027328301072573117
study1161328301073362110159200
period1377328301075095121140188238
(p1635328301072171
<17233283010753
0.001).1793328301074459104149189207220
Use3403535014375118176
of545353501436496
reliever668353501433794120144202256313348
medication10453535014399157224249302357393418482547
Eighty‑seven480370301074158104150175215241272314353394440
percent933370301074991116153193239264
of1210370301074769
the1293370301072773115
patients1421370301074988114131172218243276
reported1714370301072263110157182211251299
rescue340384301072769101141188231
medication5953843010774117167184224264290308356403
use1017384301075385129
during1170384301074995121139186235
the1424384301073380123
week15723843010765107151188
preceding1785384301074975117158199340398301074967114162
the521398301072976120
baseline661398301074990122166184202248292
visit.97339830107405991108135151
During11443983010758106131149196245
the1408398301072976119
study1546398301073563110159198
period,1764398301075094119138185234248
the340412301072875118
proportion477412301075076122171219246276294341388
of884412301074871
patients974412301074990116134177224250284
requiring1277412301072769118164182208226273321
rescue1617412301072769101141188231
medication18674123010774117340426301074866104144170187233280
at634426301074166
least71842630107155796128155
once887426301074794133174
a10754263010740
week11294263010765106149186
decreased1329426301074891130155197235267309358
to1705426301072368
19%1787426301074380145
at1946426301074166
the340440301072875118
final47744030107203986126144
visit63644030107416091109136
(p791440301072069
<8764403010753
0.001).944440301074459102147186203215
Similarly,1174440301074259132150167207232251290301
the1494440301072471115
proportion1624440301075076122171219245275293340388
of340454301074871
patients426454301075090117135177225251285
requiring729454301072365114161179204222269318
reliever106645430107226583100143183225251
medication13324543010774117166184223264290308355403
≥17504543010753
twice1822454301072491109149190
a3404683010741
week3994683010765108151189
decreased606468301074992132158200239272315364
from98946830107235096169
62%1176468301074485150
at1345468301074067
the1430468301072875118
baseline1566468301075091123167185202249293
visit187746830107415991108135
to340482301072874
8%4314823010744110
at559482301074167
the645482301072774117
final78148230107234289128146
visit94548230107416091109136
410994823010744
(p1162482301072272
<12524823010753
0.001)1323482301074459102147186203
(Fig.154448230107236381129144
2).170648230107446578
Exacerbations3405075014356111165219276311377433468493557622666
Within480524301077391117163179225
a7175243010741
period770524301075092117134179227
of1010524301074769
3months10925243010743129175222246292323
before1427524301075092114159184225
the1664524301072874116
baseline1792524301075089120162179195340538301074890
visit,44353830107405888104130145
61%of600538301074480138199221
the833538301072874116
patients962538301074989114131172218243276
suffered1250538301073479101126167192233280
froman154853830107194489161214260
acute1821538301074179125151191
flare‑up34055230107234482107148175222269
of622552301074870
asthma.70555230107407299145216255269
Between987552301074588114179220263309
the1309552301072874116
baseline1438552301074989120162180196242284
visit173555230107405889105131
and1879552301074086134
visit34056630107415889105131
14845663010744
(twoweeks),546566301071943108154232273316352386406417
an976566301074187
asthma107656630107417299145217255
flare‑up134956630107193978102143170217265
occurred1627566301074887124169194219260308
in1953566301071459
20%of340580301074485150210232
the585580301072874116
patients.714580301075089114131173219244277291
However,10185803010757103166207246287311321
between1352580301074992118183225267314
visit167858030107415889105131
118225803010744
and1879580301074187134
visit34059430107415889106132
24865943010744
(two548594301072145111157
weeks)7195943010765107150186221240
an974594301074087
exacerbation1075594301074482121160201225274313339356402449
occurred1538594301074888125171195221262310
only1862594301074895112151
in340608301071965
6%4216083010744108
of544608301074870
the632608301072673115
patients.763608301074989115132174220245278293
At1072608301075277
the1167608301072672114
end1297608301074490138
of1451608301074870
the1539608301072672114
study,1669608301073461107155193203
less189060830107175991123
than340622301072874113159
3%5166223010743107
of639622301074870
the727622301072672115
patients858622301074989115132174220245278
had1152622301074887135
an1303622301074187
asthma1406622301074173100146218257
flare‑up.168162230107224281106147174221269282
Pulmonary3406475014360123148245309374428463520
function888647501433398162216256281345409
testing1325647501433895139178203266332
Spirometry480664301074395116144194272318348377423
testing924664301074489125156177227280
at1225664301075787
the1333664301074495142
baseline14966643010766111146193214234285332
visit1849664301075778113133164
indicated340678301071967117135176217245287337
that697678301073583124151
79%868678301075193161
of1049678301075478
the1147678301073583128
patients1294678301075799126145189237264299
had1613678301075596145
a17786783010748
ventilatory184567830107489114034069230107284867109137185213257
disorder.618692301075776110160187237282310323
From961692301074975123199
this1180692301073685105138
group,1339692301075784132182233248
41%1607692301075291153
of1781692301075680
the1882692301073585130
patients340706301074990117135179226252287
suffered643706301073380103130173199241291
frommoderate‑to‑very95370630107204794167256304354397423464491533561589635664704747773815
severe1784706301073477117160186228
obstruction340720301074899132161188237278309328376425
or785720301075482
combined886720301074794169219238286331381
ventilatory1287720301074891139167186204245273320347390
disorder.1697720301075675108156183232276303315
As340734301075388
shown448734301074087136201250
in717734301072674
Fig.810734301074867116132
3,962734301075065
the1047734301073482126
proportion1193734301075683130181230257288307355403
of1616734301075579
patients1714734301075798125144188236263298
who3407483010765113161
achieved517748301074181128147190230273322
normal856748301074896122196236255
lung1130748301071663111159
functions1309748301072069116156186205252300333
according1658748301074181119166192240258306355
to340762301072875
spirometry434762301074190109136183257301329356399
increased853762301072573114141184224257302352
to1225762301073481
85%1326762301075093158
by1503762301075796
the1619762301073483127
end1766762301075098148
of1934762301075478
the340776301072876120
study.480776301073463111160200212
Evolution21402555014356109172198261298323387452
of2621255501436395
Asthma27452555014370117156220317371
Control31452555014369131195231266329355
Test35272555014358108153192
score2140269501434599161196253
The2280286301074394139
mean24472863010775120161211
ACT26782863010761112158
score2857286301074183130158202
at3080286301074876
the3177286301073585130
baseline33282863010757100134180200219268314
visit3662286301074869102121150
was21403003010766107141
16.72301300301075191108151
(SD2472300301073171129
3.8).2621300301075167113136149
During27973003010759108134154203253
follow‑up,307030030107307898117166232260309360374
the3464300301073584129
score3613300301074081129156199
increased2140314301071967107133176216249293343
continually2500314301074086135162180228275316335353393
to2913314301072571
23.83001314301074387102148
(SD3168314301072161118
1.7)330231430107445598122
at3441314301074168
the3528314301072573117
final366531430107204088128147
visit214032830107416093111139
422993283010749
(p2368328301072979
<24723283010754
0.001).2546328301074964109154194212225
At2796328301075379
the2895328301073381126
end3040328301074998147
of3207328301075377
the3304328301073381125
treatment3449328301073360103143170244288337363
period,2140342301075096123143192243259
55%2419342301075193159
of2598342301075580
patients2698342301075799127146191240268303
achieved3021342301074990139158203244288339
the3380342301073584129
highest3530342301075574124173218253282
ACT21403563010753102147
score2307356301073474121148191
(25)2517356301072467111134
(Fig.267135630107236583132148
4).283935630107446578
Pharmacological21403815014360123177212311365419481507571637662715770796
asthma29633815014356100139203300355
treatment2140395501433773130183219317376440475
According2280412301075390127172197244261307354
to2652412301072671
the2741412301072572114
study2871412301073361107154193
protocol,3080412301074974120145190230274292305
FSC3401412301074280129
therapy3548412301072672115139179227265
was21404263010766106138
prescribed2301426301075076118150190215233281325374
in2693426301072471
dosages2787426301074996129169218261293
based3103426301075091123166215
on3341426301074896
the3455426301073380123
physician’s3602426301075097135167184214044030107405796142155185
clinical234344030107456278125141180220237
judgment.2598440301072470118165237280326352366
The2982440301074795137
mean31424403010774117155202
daily3366440301074988105122161
dose3549440301075096128171
of3742440301074871
FCS2140454301074291133
prescribed2296454301075075117149188213231279322371
at2685454301074671
the2774454301073380123
baseline2920454301075090122164182199245288
visit322645430107466495112138
was33874543010765105137
7213542454301074991129
(SD3689454301072968123
289)2140468301074587129151
μg.2314468301074998113
However,24504683010758106171214254296322332
as2801468301074779
asthma2899468301074679107155228268
control3186468301074692140166192238257
improved3461468301072598147173220259302351
in2140482301071966
the2224482301073380123
course2366482301074591138163196239
of2628482301074871
the2717482301073380123
treatment,2859482301073358100139165238281328353368
the3246482301073380123
dose3392482301074997129172
of3587482301074971
FSC3676482301074786136
dropped2140496301074974119167215258307
to2465496301073176
6722562496301074483125
(SD2705496301072765120
317)2846496301074481116139
μg3006496301074895
at3119496301074470
the3207496301073177119
final334449630107274591130147
visit350949630107446293109135
(p3662496301072776
=37594963010753
0.041).214051030107435697140175190200
Modificationof23525103010769114161177198215253291315332376422481502
FSCdosage2866510301074077125185230261300346387
during3265510301074892115132177223
the3500510301072772113
study3625510301073359104150187
periodwas2140524301074991115132177224300339369
not2521524301074893118
required2651524301072666113158174198238285
for295352430107196388
nearly3053524301074789126150167204
two3269524301072792136
thirds341852430107277288112157188
of3618524301074768
the3698524301072873114
patients.2140538301075090115132174220245278293
This2447538301074290107138
implies2602538301071587135152169211243
that2863538301072470109134
themajority3015538301072470113201240257303328346372413
of3442538301074770
subjects3526538301073378126143185225253286
remained2140552301072667138177193239280328
guideline2481552301074893110157198215232277319
concordant2813552301073984130168212237283321367392
on3217552301074894
initial332955230107135975101118156173
FSC3514552301074179128
daily3655552301074887103120157
dose2140566301074995127170
with2326566301076582109155
respect249956630107256698145189228257
to2773566301072772
the2862566301072773116
12-week2994566301074479103167209252288
duration3298566301074995120159185202248295
of3609566301074870
the3697566301072673115
study.2140580301073461108156194205
Other2368580301076088135178203
medications25945803010774116165182221261286304350397429
frequently304158030107285496144190233280305322361
used3425580301074879122171
included36145803010723701091261722140594301074991139
oral2298594301074873113130
antihistamines2446594301074188113130176192223251290362379425467499
(44%2963594301072464109172
at3153594301074167
the3238594301072874117
baseline3373594301075090121164181198244286
and3678594301074087134
39%at2140608301074483149202227
the2380608301072773115
final251360830107183682120137
visit266360830107405788104130
4),280660830107436374
topical2893608301072872120137175214231
corticosteroids3137608301074084109138154193237268295335360405421468499
(10%365460830107195693158
and2140622301074187135
12%,2288622301074480144159
respectively),246062230107266899147190229258275314356373411432444
montelukast29176223010774120167192233250296332373404431
(6%and3366622301071960123177224271
10%,3651622301074381147162
respectively),2140636301072768100147190230258275314356373411432444
oral2606636301074773112130
theophylline2753636301073278121168216263300318335351397440
with3214636301076583109155
slow3387636301073855101164
release356963630107307189131169201243
(7%and2140650301072465128181227273
8%,24266503010743107122
respectively),256065030107266798145187226254271309350367405425436
systemic3009650301073372103130170241257295
corticosteroids3316650301074084109138154192236267294334358403419466497
(1.8%and214066430107246169112175228273319
1%,24716643010744102116
respectively),259966430107266697144186224252268307347364401421432
and3043664301074186133
inhaled3193664301071358103141158199246
tiotropium345166430107284489114138182230246291361
bromide2140678301075075120192209257299
(1%2457678301072260119
and2592678301074187135
1%,27436783010744103118
respectively).287867830107256698146189228257274313354372410431442
Impact21407035014325123189244298338
of2507703501436496
comorbidities26317035014354116215279315382407472497534559617662
on33227035014364128
treatment2140717501433773130183219317376440475
success26437175014346108162214270315359
rate3029717501433792128185
At2280734301075278
the2376734301072471114
baseline2505734301075090122165184201248291
visit,281173430107405990107134150
there2979734301072471114140181
was31757343010765105137
no3327734301074895
correlation3437734301074086112138179198237263281328375
between2140748301075094121187230274321
the2480748301073078121
ACT26237483010753101145
score2787748301073776122148190
and2996748301074491140
the3154748301073178122
number3298748301074894167216260285
of3605748301074871
comorbidities369574830107438921407623010772118143191208255272298315357388
(p2546762301071967
=26267623010753
0.299).2692762301074357100141183203215
Total2920762301074182107146163
asthma309776230107407198144214253
control3363762301074084130155180225242
at3619762301074065
the3698762301072773115
final214077630107244289129147
visit230477630107416091109136
424577763010744
was25187763010765106138
achieved2673776301074181128145188228270319
by3010776301074988
57%3115776301074485150
and3282776301074188136
60%3436776301074387154
of3607776301074871
patients3695776301075090394025830107284689136162196
with4154258301076583110158
no4330258301074895
or4443258301074874
one4535258301074896139
comorbidity,4692258301074086159207233282300349366394435446
compared5156258301074086159208248274316365
to5540258301072773
41%of3940272301074380139200222
patients4176272301074989115132174221246279
with4469272301076482108155
≥46382723010753
247052723010743
comorbidities4762272301074085157203229277295342359386403445477
(p5257272301072068
=53392723010753
0.019).5406272301074357100138174195207
Multivariate39402975014393157182219244298354388414467503560
analysis45272975014356120174199252297321364
A40803143010753
multivariable41563143010774120138164181221261286304343391409451
logistic4626314301072470119136167195212251
regression4895314301073273122147188221252269316363
was52813143010765105137
used5441314301074880122171
for394032830107246995
evaluation4050328301074483122140185224249266313359
of4425328301074870
the4513328301072672115
significance464332830107345098144161183201239279325364405
of5063328301074870
the5151328301072672115
impact5284328301071688136175214243
of5542328301074871
various3940342301074079102119164210240
initial419734230107135874100116153170
parameters4379342301074988111150220262287326350382
for477834230107186387
asthma487734230107407197142212250
control5139342301074084129153178222239
(according5395342301071854921281711963940356301074966112159
to4117356301072671
the4205356301072672115
ACT43353563010753100144
score).4494356301073472117142183203215
Given4724356301075673113154200
the4942356301072672115
high5072356301074865112158
number5246356301074894165213256281
of5542356301074870
these3940370301072874117149191
variables,4148370301074080105122161208226268300315
we44793703010765107
also460337030107415889135
carried4755370301074080104130147189237
out5009370301074894121
a51473703010740
subsequent5204370301073479127158201249295337383408
logistic3940384301072068119137170199217258
regression4217384301073780131157201234268286334383
analysis.46203843010751100141159200234252284301
The49403843010752103147
probability5107384301076087135185227277296315333361404
of5530384301075983
achieving3940398301074180126143185223241287335
a42933983010745
higher4360398301074865112158201225
level4603398301072366104146163
of4788398301074870
asthma4876398301074577104151222261
control5155398301074489136161186231249
significantly5422398301073854101148164394041230107244280120166191208246
decreased4209412301074991131155196235266309357
due4588412301074995137
to4743412301073277
the4838412301073279121
patient’s4982412301074989115132173220245261291
age5291412301074593135
≥54484123010754
405520412301074892
years3940426301074081119144176
(OR4134426301072783128
=42824263010754
0.552,4356426301074457100139179193
p45694263010750
=46394263010754
0.002)4713426301074457100144184204
and4937426301074187135
smoking50904263010736107154191209255303
(OR5411426301072683127
=55594263010753
0.527,394044030107435698138176180
p=41334403010749114
0.021).425944030107445799137174189200
On44724403010759106
the4590440301072773114
contrary,4717440301073983129154178217241281291
achieving5020440301074078124140181219236281328
asthma536044030107417298144214252
control3940454301074085132158183228246
was42094543010765105137
more43694543010774121146187
likely457445430107244177119136175
in4767454301072370
patients4860454301074989115132174221246279
with5162454301076583109156
a53364543010746
documented540545430107499613518139404683010774116162187227275
presence4228468301075075116148190236275315
of4556468301074870
hypersensitivity4639468301074885133176201233275321352369395412451468494535
to5187468301072872
inhalation5277468301071460106145162200226243289335
allergens394048230107415875117142188230277308
(OR4266482301072279123
=44054823010754
1.736,447548230107445394136177191
p46824823010750
=47484823010754
0.019).4818482301074457100138174194206
Discussion39405070014782114164219287338388419487556
Our40805243010760109135
results4235524301073174108155174202237
demonstrated4496524301074993167215264297326353394421464514
that5030524301073280121148
for5198524301072876103
the5320524301073381125
majority54705243010773114394053830107207099120150194
of4156538301076086
patients42635383010762106135155201252280317
with4613538301076687117168
uncontrolled48025383010760111153202253282310360381401447500
asthma5323538301075388119170246289
a39405523010742
guideline‑defined40035523010763113133184231252271322368399453499525546596643695
asthma4720552301075489120170247290
control50315523010753102154182211260281
can5334552301075396147
be55025523010763110
achieved.3940566301074284134153198240285337354
Due43215663010760110156
to4497566301073684
a46025663010749
common4671566301074897173249299349
failure504156630107317594114163190235
to5296566301073684
reach5401566301073478120162212
goals3940580301074997139158190
in4150580301071967
the4237580301072876120
management43785803010773114162203252296370414462489
of4887580301074872
asthma4979580301074174103152225266
in5264580301072068
routine5351580301072774122151169217261
clinical394059430107405977125143184225244
practice,4201594301074976118158188207247290304
we45225943010765108
included4650594301071664104123170219263313
all498059430107416078
of5075594301074872
the5166594301072573118
available5300594301074181122141159200249269313
possibilities3940608301074998131164182231249268286314332375408
for436860830107206794
improving4481608301071688137164210250269316365
the4865608301072573116
treatment500160830107245093133159232276324350
results.537160830107236598145163191225242
Guidelines39406223010756104123172216235253301345379
based4335622301075092125169219
interventions457362230107166491133160203247295321340388437470
rely506262230107246786126
on5204622301074897
a53176223010741
choice5375622301074088136155195238
of3940636301074872
an4031636301074189
appropriate4140636301074190140167214264291310351378420
antiasthmatic4580636301074189116134175208237285359399427445486
drug5085636301074975124173
with5278636301076584112160
a54586363010740
high55186363010748673940650301074997
therapeutic4057650301073482127153195244289337365384424
potential,45016503010756106133176224251269310329344
in4865650301072573
combination4957650301074794168218237285325353371420468
with5451650301076585113161
education3940664301074494141182223250269317366
and4325664301074391141
emphasis44876643010744118167216256290308341
on4849664301074897
adherence4966664301074292140184210253302342385
for5370664301072673100
improvement.54906643010721943940678301074976123162205278322370396412
We43696783010773114
showed4500678301073380128193236285
that4805678301072472112139
such4960678301073480120168
interventions514767830107166390132158201244292318337385433465
could3940692301074087135154203
lead4163692301071660100150
to4332692301072672
clinical442169230107415978126144184226245
success4686692301073178118157199233266
as4969692301074175
early5061692301074383110129169
as5248692301074074
in5341692301071764
three5425692301072574100143188
months.39407063010774122171198246279296
The4255706301074898142
results4417706301073275109156174202237
of4674706301075478
treatment4771706301073461104144171245289337364
became51557063010755100141183256301
evident54757063010750901103940720301074993141168
in4128720301071866
all421472030107416078
established4312720301074377106147197217235268315360410
efficacy474172030107446895115155197237279
indicators5040720301071967116135175216244290317351
including54117203010719671071261733940734301074967114163
the4122734301072472115
occurrence4253734301074889127174200226269316356398
of4667734301074771
day‑time4754734301074989127154181200272316
and5086734301074088136
night‑time5238734301074866115162188212240258331374
symptoms,3940748301073374148197224270343376392
limitation4351748301071634107125153194220239286334
in4705748301071563
activities,4784748301074081110129170189216235278311327
use5127748301074880124
of5267748301074871
reliever535874830107236584102146186229255
medication,39407623010776121173193235278306326375426442
exacerbations,4403762301075293136178222250301345373393442493527544
spirometry4968762301074192112140188265311340368412
results,5401762301073479114163183394077630107286379
and4038776301074593143
ACT42047763010753102147
score.4371776301073878125152195209
At4604776301075379
the4703776301073280124
end4847776301074795145
of5015776301074872
the5107776301073280124
treatment5251776301073158101141168242287335362
p34075808339
<39475808342
0.001451758083344782118150
Day-time195410030834578108130153168226261
symptoms223010030832659117157179216274300
Fig.34260001124771125149
1.50960001125071
Occurrence62560501075897132177203229265312349385
of102760501074568
day-time111160501074590127154180199270308
and143560501074592137
night-time158860501074664110156181205232250321359
symptoms196360501073168140185211254326356
(n233560501072468
=2419605010753
494)248960501074181123144
Baseline7882303083356895130145160198233
visit1037230308331477388110
Visit1350230308336527893115
11481230308334
Visit1809230308336527893115
21940230308334
Visit2269230308336527893115
32400230308334
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42853230308334
Night-time19541101083456099137158178200216273308
symptoms/awakings227811010832658117156178215273300326356407440470486524563589
938459700833467
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81101110960833466
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31221117390833465
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10032229190833466102
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1004879190833466102
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p309675808339
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0.0013207758083344782118150
Once476810250834786118151
a4935102508332
week498210250835085120151
Fig.308359901124771125149
2.325059901125076
Use337060401075483121
of350760401074568
reliever3591604010726638199137176213238
medication3846604010771109155173210254280298344390
(n425260401072468
=4336604010754
494)440660401074281123145
Baseline35212303083356894129145160197232
visit3766230308331477388110
Visit4029230308336527893115
14160230308334
Visit4444230308336527893115
24575230308334
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Visit5268230308336527893115
45397230308334
Two476811060833380117
or489911060833759
more497111060835896118152
thimes51381106083205873131166193
a5344110608332
week539011060835085120150
Patients31311810471283356789104139177198226
(%)31311569471283197087
Patients3601810471283356789104139177198226
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90325910490833470
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