Original Articles: Asthma Lower Airway Diseases
Asthmatic patients’ poor awareness of inadequate disease control: a pharmacy-based survey

https://doi.org/10.1016/S1081-1206(10)60687-4Get rights and content

Background

Many asthmatic patients fail to perceive their level of disease control.

Objective

To investigate whether patients’ ability to identify asthma control varied with personal characteristics or factors related to disease management.

Methods

Asthmatic patients were consecutively recruited at 348 pharmacies. They completed a questionnaire (regarding personal characteristics and asthma management) linked to pharmacies records of dispensed medications. The Asthma Control Test questionnaire includes 4 dimensions of asthma control (activity limitations, dyspnea, nocturnal awakenings, and rescue medication use) and assesses patients’ perception of control (“How would you rate your asthma control during the past 14 days?”). Analyses were restricted to patients with inadequate control. Patients’ perception of control was compared across the other dimensions of the questionnaire. The correlates of patients’ failure to perceive inadequate asthma control were investigated.

Results

Seven hundred eighteen (68.5%) of the 1,048 patients with inadequate asthma control and documented perception of control considered themselves to be “completely” or “well” controlled. Patients’ perception of control did not vary with each dimension of inadequate control. High rates of failure to perceive poor control were observed in patients with at least weekly dyspneas (60%) or nocturnal symptoms (60%). Failure to perceive inadequate control was more likely in patients aged 41 to 50 years (odds ratio, 1.51; 95% confidence interval, 1.05-2.15). No significant effect of factors related to asthma management was observed.

Conclusions

Patients with most uncontrolled asthma have difficulty in properly perceiving their level of disease control regardless of their personal characteristics or disease management. The reasons for this poor perception should be investigated. Education programs should be created that focus on knowledge of asthma miscontrol criteria.

Section snippets

INTRODUCTION

The level of asthma control remains inadequate for most patients in Western countries despite the emergence of new effective controller therapies. 1, 2 In addition, studies 3, 4 have reported that many patients fail to notice inadequate control of their disease. A pharmacy-based observational study 5 was conducted in 2004 among asthmatic patients. Asthma control was measured using the Asthma Control Test, 6 and patients described how they perceived their own disease control. A substantial

Study Design and Study Population

The methods of the study have already been described. 5 Briefly, an observational study was conducted in 348 French community pharmacies between November 2003 and June 2004. Community pharmacists invited asthmatic patients aged 18 to 50 years who were regular users of the pharmacy to participate in the study. To be eligible, patients were required to have with them a prescription for an antiasthma medication (R03, Anatomical Therapeutic Chemical Classification). In case of refusal, the next

Patient Characteristics

The main characteristics of the patients have already been described. 5 Briefly, most of the 1,559 patients were women (56%), and the mean age was 36 years. More than 30% of the patients were smokers. Most patients were dispensed fixed combinations of long-acting β-agonists (LABAs) and inhaled corticosteroids (ICSs) before study inclusion, alone (26%) or associated with another controller (33%). Approximately 15% of the patients received LABAs and ICSs as 2 separate medications, whereas 8% were

DISCUSSION

This is one of the few observational studies investigating patients’ difficulty perceiving inadequate asthma control. Most patients with inadequate asthma control did not perceive this, even when highly symptomatic. This poor perception of asthma control was not specific to any dimension of control. In addition, the failure to identify inadequate control did not markedly vary with personal characteristics, except for age and smoking status. Last, no substantial effect of asthma management was

ACKNOWLEDGMENTS

We thank the pharmacists and patients who agreed to participate in this study.

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    This study was supported in part by a nonconditional grant from GlaxoSmithKline France.

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