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Understanding patients’ perceptions of asthma control: a qualitative study

Natalie Bidad, Neil Barnes, Chris Griffiths, et al.
Eur Respir J. 2018;51:1701346
doi: 10.1183/13993003.01346-2017

Optimal asthma control consists of preventing symptoms, minimising attacks, enabling ordinary levels of physical activity, and achieving near-normal lung function, while also minimising adverse effects from medication. However, patients’ perceptions of well-controlled asthma often differ considerably from healthcare professionals’, with few patients considering their asthma ‘uncontrolled’ even while experiencing significant morbidity.

In this study, quantitative interviews were conducted with 42 patients recruited from a primary care asthma clinic and a hospital asthma outpatient clinic. Participants fell into two groups regarding their views on preventer medication. The smaller group acknowledged the importance of taking medication in the absence of symptoms. However, the majority of patients used this medication to treat symptoms only when they exceeded their personally defined tolerance threshold. Some patients also believed that preventer medication should only be used to prevent an exacerbation occurring when they started experiencing worsening of symptoms.

Concerns about adverse effects of medication – potential or actual – were common. This was particularly true of corticosteroids, which were perceived as much more dangerous than short-acting bronchodilators. Patients were also concerned that taking medication frequently or for prolonged periods meant it would be less effective in an attack.

Finally, asthma reviews were considered a ‘waste of time’ and a bureaucratic step necessary only to obtain another prescription. However, contradictorily, patients felt that healthcare professionals focused too heavily on pharmacological treatment in asthma management discussions.

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