A qualitative study of the impact of severe asthma and its treatment showing that treatment burden is neglected in existing asthma assessment scales

Hyland, Michael E.; Whalley, Ben; Jones, Rupert; Masoli, Matthew

doi:10.1007/s11136-014-0801-x

Cited by 101 publications

(125 citation statements)

References 29 publications

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“…Our study confirmed that the treatment-burden themes and subthemes proposed by Eton et al24 and previously described in other chronic conditions, such as stroke,5,13 diabetes,5,14,15 asthma,16,17 and cystic fibrosis,18,19 were highly relevant for patients with COPD. The results of this study also suggest that as in other chronic conditions, COPD patients weigh the perceived burdens of treatment against their benefits.…”

Section: Discussionsupporting

confidence: 91%

“…The treatment burden for some other chronic conditions, such as stroke,5,13 diabetes,5,14,15 asthma,16,17 and cystic fibrosis,18,19 has been studied, and important burdens have been reported, including poor communication with health care providers, medication burden, time burden, and emotional distress. It is likely that the treatment burden is similarly important, especially in severe COPD, given the high number of demanding treatments.…”

Section: Introductionmentioning

confidence: 99%

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Patient-perceived treatment burden of chronic obstructive pulmonary disease

Harb

Foster

Dobler

2017

COPD

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BackgroundWhile chronic morbidity and mortality from COPD is well documented, little is known about the treatment burden faced by patients with COPD.Subjects and methodsPatients with severe airflow obstruction (forced expiratory volume in 1 second [FEV1] <50% predicted) representing different age-groups, sex, and number of comorbidities participated in a semistructured interview. Interviews were conducted until thematic saturation was reached. Interviews were recorded, transcribed, and analyzed thematically using an established treatment-burden framework.ResultsA total of 26 patients (42% male, mean age 66.7±9.8 years) with severe (n=15) or very severe (n=11) airflow limitation (mean FEV1 32.1%±9.65% predicted) were interviewed. Participants struggled with various treatment-burden domains, predominantly with changing health behaviors, such as smoking cessation and exercise. Interviewees often only ceased smoking after a major health event, despite being advised to do so earlier by a doctor. Recommended exercise regimens, such as pulmonary rehabilitation classes, were curtailed, although some patients replaced them with light home-based exercise. Interviewees had difficulty attending medical appointments, often relying on others to transport them. Overall, COPD patients indicated they were not willing to accept the burden of treatments where they perceived minimal benefit.ConclusionThis study describes the substantial treatment burden experienced by patients with COPD. Medical advice may be rejected by patients if the benefit of following the advice is perceived as insufficient. Health professionals need to recognize treatment burden as a source of nonadherence, and should tailor treatment discussions to fit patients’ values and capacity to achieve optimal patient outcomes.

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Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Patient-perceived treatment burden of chronic obstructive pulmonary disease

Harb

Foster

Dobler

2017

COPD

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“…Regular use of OCS in asthma is however associated with greater risks of systemic corticosteroid-related complications [14]. The short- and long-term detrimental adverse effects includes osteoporosis, diabetes and heart failure [15–17] and the consequences appear to be related to the exposure time and OCS dosage [18].…”

Section: Introductionmentioning

confidence: 99%

Health care resource utilization and cost for asthma patients regularly treated with oral corticosteroids – a Swedish observational cohort study (PACEHR)

et al. 2018

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BackgroundPatients with severe uncontrolled asthma may receive oral corticosteroid (OCS) treatment regularly. The present study investigated the health care resource utilization and cost in regularly OCS treated Swedish asthma patients.Methods Primary care medical records data were linked to data from Swedish national health registries. Patients ≥18 years with a drug claim for obstructive pulmonary diseases during 2007–2009 (index date) and a prior asthma diagnosis, were classified by their OCS claims during the 12-months’ post index period: regular OCS equals ≥5 mg per day; periodic OCS less than 5 mg per day; or non-OCS users. Cost of asthma- and OCS-morbidity-related health care resource utilization were calculated.ResultsA total of 15,437 asthma patients (mean age 47.8, female 62.6%), whereof 223 (1.44%) were regular OCS users, 3054 (19.7%) were periodic, and 12,160 (78.7%) were non-OCS users. Regular OCS users were older and more often females, had lower lung function, greater eosinophil count and more co-morbidities at baseline compared with the other groups. Age-adjusted annual total health care cost was three-times greater in the regular OCS group (€5615) compared with the non-OCS users (€1980) and twice as high as in the periodic OCS group (€2948). The major cost driver in the non-OCS and periodic OCS groups were primary care consultations, whereas inpatient costs were the major cost driver in the regular OCS group. The asthma related costs represented 10–12% of the total cost in all three groups.ConclusionIn this real-life asthma study in Sweden, the total yearly cost of health care resource utilization for a regular OCS user was three times greater than for a patient with no OCS use, indicating substantial economic and health care burden for asthma patients on regular oral steroid treatment.

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“…Most validated measures of treatment burden have been developed for specific chronic conditions, such as diabetes and asthma [12,13]. Even within some of these studies, treatment burden has generally been included as one component within a multidimensional instrument, specifically designed to measure overall quality of life and treatment satisfaction [10].…”

mentioning

confidence: 99%

Treatment Burden and Chronic Illness: Who is at Most Risk?

Sav

Whitty

McMillan

et al. 2016

Patient

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Background: There is a need to ascertain the type and level of treatment burden experienced by people with co-morbidities. This is important to identify the characteristics of participants who are at most risk of treatment burden. Objective: The aim of this study is to identify the characteristics of participants who are at most risk of treatment burden. Methods: This cross-sectional study was part of a larger project and recruitment was conducted across four Australian regions: rural, semi-rural and metropolitan. Participants were asked about their treatment burden using an adapted version of a measure, which included the following five dimensions: medication, time and administrative, lifestyle change, social life and financial burden. Results: In total, 581 participants with various chronic health conditions reported a mean global treatment burden of 56.5 out of 150 (standard deviation = 34.5). Number of chronic conditions (β = .34, p < 0.01), age, (β = −.27, p < 0.01), the presence of an unpaid carer (β = .22, p < 0.001) and the presence of diabetes mellitus and other endocrine conditions (β = .13, p < 0.01) were significant predictors of overall treatment burden. For the five dimensions of treatment burden, social, medicine and administrative burden were predicted by the same cluster of variables: number of conditions, age, presence of an unpaid carer and diabetes. However, in addition to these variables, financial dimensions were also predicted by education level, ethnicity and health insurance. Educational level also influenced lifestyle burden. Conclusion: A substantial proportion of community-dwelling adults with chronic conditions have considerable levels of treatment burden. Specifically, health professionals should provide greater focus on managing overall treatment burden for persons who are of young age, have an endocrine condition or an unpaid carer, or a combination of these factors

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A qualitative study of the impact of severe asthma and its treatment showing that treatment burden is neglected in existing asthma assessment scales

Cited by 101 publications

References 29 publications

Patient-perceived treatment burden of chronic obstructive pulmonary disease

Patient-perceived treatment burden of chronic obstructive pulmonary disease

Health care resource utilization and cost for asthma patients regularly treated with oral corticosteroids – a Swedish observational cohort study (PACEHR)

Treatment Burden and Chronic Illness: Who is at Most Risk?

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