Health Beliefs of Adults with Asthma: Toward an Understanding of the Difference Between Symptomatic and Preventive Use of Inhaler Treatment

Abstract

The aim of this study was to examine the potential differences between beliefs relating to symptomatic and preventive inhaler treatment and to analyze the relationship between these beliefs and the use of inhalers by adult patients with asthma in general practice. Unstructured interviews with a stratified sample of 8 patients, taking a combination of salbutamol and beclomethasone inhalers, were used to develop themes for a structured interview, where questions relating to 8 main areas of interest were measured on a 5-point Likert scale. Forty patients prescribed the same combination of inhalers were randomly selected for the structured interview. All agreed to participate (100% response). Correlations between the responses to the 8 themes and measures of inhaler use were analyzed. High use of salbutamol for the relief of symptoms and low use of beclomethasone for the prevention of asthma were common. Perceived benefits of the inhalers, a positive attitude to using the inhalers, and concern about side effects had strong influences on the use of both inhalers. Uncertainty about the inhalers, a negative attitude to using the inhalers, and the involvement of others in asthma management had less influence on inhaler use. Satisfaction with the doctor and the ease of obtaining an inhaler were more important issues for beclomethasone use than for salbutamol use. There are important differences in the beliefs that patients hold in relation to symptomatic and preventive use of inhaler treatment. These findings suggest that focusing on very specific attitudes to treatment may be of benefit in the health education of adults with asthma. Further work is planned to refine the themes so that doctors will be able to explore patients' views about their inhaler treatment by asking a few direct questions.

Predictors of Poor Asthma Control in European Adults

“…Poor asthma control was associated with poor asthma knowledge, a negative attitude, and more fears about the side effects of inhaled corticosteroids. Our findings are supported by previous studies that found that patient behavior and use of asthma medication are linked in a complex manner to personal attitudes and understanding of asthma and its treatment (9)(10)(11)23,24). In addition, patient satisfaction with their doctor (10) and good doctor-patient communication (25) are major factors influencing patient use of inhaled corticosteroids.…”

“…In particular, poor patient knowledge of asthma and self-management skills as well as individual beliefs, attitudes, and behavior may contribute to poor adherence with prescribed asthma medication, which in turn will result in poor asthma control (8)(9)(10)(11)(12). To better understand asthma control from the patient's perspective, we have examined the attitudes, knowledge, and behavior of the adult asthmatics in the AIRE survey.…”

Beliefs About Asthma Medications: Patients Perceive Both Benefits and Drawbacks

“…Perceiving drawbacks of asthma medications may contribute to worse adherence, whereas having strong beliefs in the benefits of asthma medications may contribute to better adherence (2)(3)(4). Patients taking asthma medications must concurrently weigh the necessity for medications and their concerns about potential adverse effects, both of which may affect adherence (3).…”

Patient adherence with COPD therapy

“…Studies by SPECTOR et al [10], MAWHINNEY and coworkers [11,12], YEUNG et al [13], RAND and coworkers [14][15][16] and others, which used electronic monitoring of pMDI dispensing, suggest that average adherence to asthma and COPD regimens is ,50% of prescribed, and may dip much lower [16]. Studies in both asthma and COPD also suggest that, while patients tend to under-use controller or maintenance therapies, symptom-relieving drugs such as bronchodilators are often overused [17,18].…”