Can asthma control be improved by understanding the patient's perspective?

Abstract

BackgroundClinical trials show that asthma can be controlled in the majority of patients, but poorly controlled asthma still imposes a considerable burden. The level of asthma control achieved reflects the behaviour of both healthcare professionals and patients. A key challenge for healthcare professionals is to help patients to engage in self-management behaviours with optimal adherence to appropriate treatment. These issues are particularly relevant in primary care, where most asthma is managed. An international panel of experts invited by the International Primary Care Respiratory Group considered the evidence and discussed the implications for primary care practice.DiscussionCauses of poor controlClinical factors such as exposure to triggers and concomitant rhinitis are important but so are patient behavioural factors. Behaviours such as smoking and nonadherence may reduce the efficacy of treatment and patients' perceptions influence these behaviours. Perceptual barriers to adherence include doubting the need for treatment when symptoms are absent and concerns about potential adverse effects. Under-treatment may also be related to patients' underestimation of the significance of symptoms, and lack of awareness of achievable control.ImplicationsThree key implications for healthcare professionals emerged from the debate. First, the need for simple tools to assess asthma control. Two approaches considered were the monitoring of biometric markers of control and questionnaires to record patient-reported outcomes. Second, to understand the reasons for poor control for individual patients, identifying both clinical (e.g. rhinitis) and behavioural factors (e.g. smoking and nonadherence to treatment). Third was the need to incorporate, within asthma review, an assessment of patient perspectives including their goals and aspirations and to elicit their beliefs and concerns about asthma and its treatment. This can be used as a basis for agreement between the healthcare professional and patient on a predefined target regarding asthma control and a treatment plan to achieve this.SummaryOptimum review of asthma is essential to improve control. A key priority is the development of simple and effective tools for identifying poor control for individual patients coupled with a tailored approach to treatment to enable patients to set and achieve realistic goals for asthma control.

The Asthma Control Test (ACT) as an alternative tool to Global Initiative for Asthma (GINA) guideline criteria for assessing asthma control in Vietnamese outpatients

“…This is important in clinical practice because these patients need to have their treatment reviewed as well as addressing risk factors for poor asthma control. 30 A study of 382 patients in Hong Kong found that the ACT could predict step-up of asthma therapy in 70.2% of consultations, 13 suggesting that this tool could actually assist doctors' treatment decisions. Indeed, Ko et al found that the ACT correlates better with treatment decisions made by asthma specialists than spirometry, PEF, or fractional exhaled nitric oxide measurements.…”

Patients' perspectives on foot complications in type 2 diabetes: a qualitative study

“…[32][33][34] Therefore, it has been suggested that health professionals should routinely try to elicit patients' beliefs about their condition. [39][40][41] Misperceptions that might affect health outcomes may be detected and can then be addressed and treatment or self-management negotiated. In a recent quasi-experimental study, GPs received training for 6 hours in ways to elicit patients' illness beliefs.…”

Assessing asthma control in routine clinical practice: use of the Royal College of Physicians ‘3 Questions’

“…3 There is evidence that clinicians frequently over-estimate asthma control and under-estimate the impact of asthma on patents' lives. [4][5][6] The British Thoracic Society and Scottish Intercollegiate Guidelines Network UK guidelines for the management of asthma 7 recommend that the Royal College of Physicians (RCP) '3 questions' 8 should be asked at all asthma clinical assessments to assess patient morbidity. This simple, quick, and easy-to-use questionnaire has, however, never been validated as a useful tool for routine clinical practice.…”