Patient preferences for asthma management: a qualitative study

Abstract

ObjectivePreference for asthma management and the use of medications is motivated by the interplay between lived experiences of asthma and patients’ attitudes towards medications. Many previous studies have focused on individual aspects of asthma management, such as the use of preventer and reliever inhalers. The aim of this qualitative study was to explore the preferences of patients with mild-moderate asthma for asthma management as a whole and factors that influenced these preferences.DesignA qualitative study employing qualitative descriptive analysis situated within a constructionist epistemology to analyse transcribed audio recordings from focus groups.SettingThree locations within the greater Wellington area in New Zealand.ParticipantsTwenty-seven adults with self-reported doctor’s diagnosis of asthma, taking short-acting beta-agonists alone or inhaled corticosteroids with or without long-acting beta2-agonist, who had used any inhaled asthma medication within the last month.ResultsFour key areas described preferences for asthma management. Preferences for self-management: participants wanted to be in control of their asthma and developed personal strategies to achieve this. Preferences for the specific medications or treatment regimen: participants preferred regimens that were convenient and reliably relieved symptoms. Preferences for inhaler devices: devices that had dose counters and were easy to use and portable were important. Preferences for asthma services: participants wanted easier access to their inhalers and to be empowered by their healthcare providers. Participant preferences within each of these four areas were influenced by the impact asthma had on their life, their health beliefs, emotional consequences of asthma and perceived barriers to asthma management.ConclusionsThis study illustrates the interaction of the lived experience of asthma, factors specific to the individual, and factors relating to asthma treatments in shaping patient preferences for asthma management. This aids our understanding of preferences for asthma management from the patient perspective.Trial registration numberAustralian New Zealand Clinical Trials Registry (ACTRN12619000601134).

Perspectives of mild asthma patients on maintenance versus as-needed preventer treatment regimens: a qualitative study

“…In our interviewees, there was generally limited knowledge about asthma, and a tendency to believe that their personal asthma risk was low. These patient perspectives are of obvious concern because, as in other research,16 they appeared to influence attitudes toward, and implementation of, prescribed preventer treatment. For example, the perception of low health risk from asthma combined with limited asthma knowledge meant that the necessity for an additional (ie, preventer) treatment was unclear especially when no direct physical benefit could be observed after using the ICS-containing inhaler.…”

“…A recent qualitative study among patients predominantly prescribed maintenance ICS/long-acting beta2-agonist reported a lack of understanding about asthma as a barrier to self-management, and doubts about the necessity of ICS. 16 The poor patient disease education in our interviewees with mild asthma may explain misconceptions about the (low) risk of their disease, a finding observed in studies of patients with more severe asthma. 17 Education in mild asthma patients is urgently needed to increase understanding of the potential for severe exacerbations even in mild asthma, 18 19 and the ability of ICS-containing treatment…”

“…A desire for convenient, simple treatments (easy to know when or how to take) has been reported in other asthma research. 16 Indeed, those receiving the 'Maintenance' regimen reported a range of implementation problems with their daily preventer that that did not interfere with the 'As-needed combination' regimen, such as difficulty establishing an effective preventertaking routine or forgetting preventer treatment when symptoms were not present. Similarly, in the INSPIRE study, the proportion of patients underusing their maintenance medication was significantly higher when they felt well (34%) compared with periods of worsening asthma (18%).…”

More options for managing severe asthma in adults

“…4 Reasons for the large non-adherence to the protocol (T2-biomarker group=42%, controls=33%), 4 and especially the reluctance to alter corticosteroid doses when advised to do so, are unknown. In light of data showing that patients' asthma management preferences are "influenced by the impact asthma had on their life, health beliefs, emotional consequences of asthma and perceived barriers to asthma management", 5 it is probable that the participants' preference not to alter their current treatment is at least, in part, because of their high level of asthma symptoms in terms of frequency and severity. This reluctance to reduce high corticosteroid doses under clinical guidance suggests that it might be important to measure predictive biomarkers of therapeutic response before increasing corticosteroid doses in patients with severe asthma.…”

“…4 Then, a decade later, SLS II showed mycophenolate mofetil to be as effective and better tolerated than cyclophosphamide in this patient population. 5 Accordingly, mycophenolate mofetil has become a cornerstone of SSc-ILD management in many countries throughout North America and Europe, despite the paucity of a placebo-controlled phase 3 clinical trial supporting this approach. This reality was sure to affect the interpretation of the SENSCIS trial results, because nearly half of trial participants were treated with mycophenolate (mofetil or sodium) at the time of enrolment.…”