A multinational observational study identifying primary care patients at risk of overestimation of asthma control

Vicky Kritikos; David Price; Alberto Papi; Antonio Infantino; Bjorn Ställberg; Dermot Ryan; Federico Lavorini; Henry Chrystyn; John Haughney; Karin Lisspers; Kevin Gruffydd-Jones; Miguel Román Rodríguez; Svein Høegh Henrichsen; Thys van der Molen; Victoria Carter; Sinthia Bosnic-Anticevich

doi:10.1038/s41533-019-0156-4

A multinational observational study identifying primary care patients at risk of overestimation of asthma control

Vicky Kritikos, David Price, Alberto Papi, Antonio Infantino, Bjorn Ställberg, Dermot Ryan, Federico Lavorini, Henry Chrystyn, John Haughney, Karin Lisspers, Kevin Gruffydd-Jones, Miguel Román Rodríguez, Svein Høegh Henrichsen, Thys van der Molen, Victoria Carter, Sinthia Bosnic-Anticevich

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Abstract

Factors related to the discrepancy between patient-perceived and actual disease control remain unclear. Identifying patients at risk of overestimation of asthma control remains elusive. This study aimed to (i) investigate the relationship between patient-reported and actual level of asthma control (ii), compare the characteristics between patients who believe their asthma is well controlled that accurately report ‘well-controlled’ asthma with those that do not, and (iii) identify factors associated with inaccurately reported ‘well-controlled’ asthma. A historical, multinational, cross-sectional study using data from the iHARP (initiative Helping Asthma in Real-life Patients) review service for adults with asthma prescribed fixed-dose combination therapy. Data from 4274 patients were analysed. A major discrepancy between patient-reported and Global Initiative for Asthma defined asthma control was detected; 71.1% of patients who reported ‘well-controlled’ asthma were inaccurate in their perception despite receiving regular maintenance therapy. Significant differences were noted in age, gender, body mass index, education level, medication use, side effects, attitudes to preventer inhaler use, inhaler technique review and respiratory specialist review between patients who accurately reported ‘well-controlled’ asthma and those who did not. Independent risk factors associated with inaccurately reported ‘well-controlled’ asthma were: having taken a maximum of 5–12 puffs or more of reliever inhaler on at least one day within the previous 4 weeks; being female; having seen a respiratory specialist more than a year ago (rather than in the previous year); and having required oral corticosteroids for worsening asthma in the previous year. The study highlighted the significant hidden burden associated with under-recognition of poor asthma control, on the part of the patient and the need for targeted interventions designed to address the continuing discrepancy between perceived and actual disease control.

Original language	English
Article number	43
Pages (from-to)	1-9
Number of pages	9
Journal	npj Primary Care Respiratory Medicine
Volume	29
DOIs	https://doi.org/10.1038/s41533-019-0156-4
Publication status	Published - 5 Dec 2019
Externally published	Yes

Bibliographical note

Copyright the Author(s) 2019. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.

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Publisher version (open access)Final published version, 700 KBLicence: CC BY

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Kritikos, V., Price, D., Papi, A., Infantino, A., Ställberg, B., Ryan, D., Lavorini, F., Chrystyn, H., Haughney, J., Lisspers, K., Gruffydd-Jones, K., Román Rodríguez, M., Høegh Henrichsen, S., van der Molen, T., Carter, V., & Bosnic-Anticevich, S. (2019). A multinational observational study identifying primary care patients at risk of overestimation of asthma control. npj Primary Care Respiratory Medicine, 29, 1-9. [43]. https://doi.org/10.1038/s41533-019-0156-4

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title = "A multinational observational study identifying primary care patients at risk of overestimation of asthma control",

abstract = "Factors related to the discrepancy between patient-perceived and actual disease control remain unclear. Identifying patients at risk of overestimation of asthma control remains elusive. This study aimed to (i) investigate the relationship between patient-reported and actual level of asthma control (ii), compare the characteristics between patients who believe their asthma is well controlled that accurately report {\textquoteleft}well-controlled{\textquoteright} asthma with those that do not, and (iii) identify factors associated with inaccurately reported {\textquoteleft}well-controlled{\textquoteright} asthma. A historical, multinational, cross-sectional study using data from the iHARP (initiative Helping Asthma in Real-life Patients) review service for adults with asthma prescribed fixed-dose combination therapy. Data from 4274 patients were analysed. A major discrepancy between patient-reported and Global Initiative for Asthma defined asthma control was detected; 71.1% of patients who reported {\textquoteleft}well-controlled{\textquoteright} asthma were inaccurate in their perception despite receiving regular maintenance therapy. Significant differences were noted in age, gender, body mass index, education level, medication use, side effects, attitudes to preventer inhaler use, inhaler technique review and respiratory specialist review between patients who accurately reported {\textquoteleft}well-controlled{\textquoteright} asthma and those who did not. Independent risk factors associated with inaccurately reported {\textquoteleft}well-controlled{\textquoteright} asthma were: having taken a maximum of 5–12 puffs or more of reliever inhaler on at least one day within the previous 4 weeks; being female; having seen a respiratory specialist more than a year ago (rather than in the previous year); and having required oral corticosteroids for worsening asthma in the previous year. The study highlighted the significant hidden burden associated with under-recognition of poor asthma control, on the part of the patient and the need for targeted interventions designed to address the continuing discrepancy between perceived and actual disease control.",

author = "Vicky Kritikos and David Price and Alberto Papi and Antonio Infantino and Bjorn St{\"a}llberg and Dermot Ryan and Federico Lavorini and Henry Chrystyn and John Haughney and Karin Lisspers and Kevin Gruffydd-Jones and {Rom{\'a}n Rodr{\'i}guez}, Miguel and {H{\o}egh Henrichsen}, Svein and {van der Molen}, Thys and Victoria Carter and Sinthia Bosnic-Anticevich",

note = "Copyright the Author(s) 2019. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.",

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Kritikos, V, Price, D, Papi, A, Infantino, A, Ställberg, B, Ryan, D, Lavorini, F, Chrystyn, H, Haughney, J, Lisspers, K, Gruffydd-Jones, K, Román Rodríguez, M, Høegh Henrichsen, S, van der Molen, T, Carter, V & Bosnic-Anticevich, S 2019, 'A multinational observational study identifying primary care patients at risk of overestimation of asthma control', npj Primary Care Respiratory Medicine, vol. 29, 43, pp. 1-9. https://doi.org/10.1038/s41533-019-0156-4

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AU - Price, David

AU - Papi, Alberto

AU - Infantino, Antonio

AU - Ställberg, Bjorn

AU - Ryan, Dermot

AU - Lavorini, Federico

AU - Chrystyn, Henry

AU - Haughney, John

AU - Lisspers, Karin

AU - Gruffydd-Jones, Kevin

AU - Román Rodríguez, Miguel

AU - Høegh Henrichsen, Svein

AU - van der Molen, Thys

AU - Carter, Victoria

AU - Bosnic-Anticevich, Sinthia

N1 - Copyright the Author(s) 2019. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.

PY - 2019/12/5

Y1 - 2019/12/5

N2 - Factors related to the discrepancy between patient-perceived and actual disease control remain unclear. Identifying patients at risk of overestimation of asthma control remains elusive. This study aimed to (i) investigate the relationship between patient-reported and actual level of asthma control (ii), compare the characteristics between patients who believe their asthma is well controlled that accurately report ‘well-controlled’ asthma with those that do not, and (iii) identify factors associated with inaccurately reported ‘well-controlled’ asthma. A historical, multinational, cross-sectional study using data from the iHARP (initiative Helping Asthma in Real-life Patients) review service for adults with asthma prescribed fixed-dose combination therapy. Data from 4274 patients were analysed. A major discrepancy between patient-reported and Global Initiative for Asthma defined asthma control was detected; 71.1% of patients who reported ‘well-controlled’ asthma were inaccurate in their perception despite receiving regular maintenance therapy. Significant differences were noted in age, gender, body mass index, education level, medication use, side effects, attitudes to preventer inhaler use, inhaler technique review and respiratory specialist review between patients who accurately reported ‘well-controlled’ asthma and those who did not. Independent risk factors associated with inaccurately reported ‘well-controlled’ asthma were: having taken a maximum of 5–12 puffs or more of reliever inhaler on at least one day within the previous 4 weeks; being female; having seen a respiratory specialist more than a year ago (rather than in the previous year); and having required oral corticosteroids for worsening asthma in the previous year. The study highlighted the significant hidden burden associated with under-recognition of poor asthma control, on the part of the patient and the need for targeted interventions designed to address the continuing discrepancy between perceived and actual disease control.

AB - Factors related to the discrepancy between patient-perceived and actual disease control remain unclear. Identifying patients at risk of overestimation of asthma control remains elusive. This study aimed to (i) investigate the relationship between patient-reported and actual level of asthma control (ii), compare the characteristics between patients who believe their asthma is well controlled that accurately report ‘well-controlled’ asthma with those that do not, and (iii) identify factors associated with inaccurately reported ‘well-controlled’ asthma. A historical, multinational, cross-sectional study using data from the iHARP (initiative Helping Asthma in Real-life Patients) review service for adults with asthma prescribed fixed-dose combination therapy. Data from 4274 patients were analysed. A major discrepancy between patient-reported and Global Initiative for Asthma defined asthma control was detected; 71.1% of patients who reported ‘well-controlled’ asthma were inaccurate in their perception despite receiving regular maintenance therapy. Significant differences were noted in age, gender, body mass index, education level, medication use, side effects, attitudes to preventer inhaler use, inhaler technique review and respiratory specialist review between patients who accurately reported ‘well-controlled’ asthma and those who did not. Independent risk factors associated with inaccurately reported ‘well-controlled’ asthma were: having taken a maximum of 5–12 puffs or more of reliever inhaler on at least one day within the previous 4 weeks; being female; having seen a respiratory specialist more than a year ago (rather than in the previous year); and having required oral corticosteroids for worsening asthma in the previous year. The study highlighted the significant hidden burden associated with under-recognition of poor asthma control, on the part of the patient and the need for targeted interventions designed to address the continuing discrepancy between perceived and actual disease control.

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A multinational observational study identifying primary care patients at risk of overestimation of asthma control

Abstract

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