Journal of Asthma and Allergy (Oct 2022)
Suboptimal Control of Asthma Among Diverse Patients: A US Mixed Methods Focus Group Study
Abstract
Maureen George,1 Zaneta Balantac,2 Chris Gillette,3 Nabeel Farooqui,4 Tommi Tervonen,5 Caitlin Thomas,5 Ileen Gilbert,6 Hitesh Gandhi,6 Elliot Israel7 1School of Nursing, Columbia University, New York, NY, USA; 2Patient-Centered Research, Evidera, San Francisco, CA, USA; 3Department of Physician Assistant Studies, Wake Forest School of Medicine, Winston-Salem, NC, USA; 4Allergy Partners, Fishers, IN, USA; 5Patient-Centered Research, Evidera, London, UK; 6Medical Affairs-Respiratory, AstraZeneca, Wilmington, DE, USA; 7Brigham & Women’s Hospital, Harvard Medical School, Boston, MA, USACorrespondence: Maureen George, School of Nursing at CUIMC, Columbia University School of Nursing, 630 West 168th Street Mail Code 6, New York, NY, 10032, USA, Tel +1 212-305-1175 ; Tel +1 212-305-1175, Email [email protected]: The US National Asthma Education and Prevention Program updates and Global Initiative for Asthma report encourage considering the patient perspective to improve asthma control. The objective of the present study was to collect data about the perceptions, experiences, and concerns of adult patients and caregivers of children with asthma regarding rescue, maintenance, and oral corticosteroid treatments.Patients and Methods: In-person focus groups were conducted in three cities across the US. Participants also completed patient-reported outcome measures assessing asthma control and experiences.Results: Focus groups were conducted in demographically and clinically diverse adults with asthma (five groups, n=34), caregivers of children with asthma (five groups, n=35), and adults with a dual diagnosis of asthma and chronic obstructive pulmonary disease (one group, n=5). Only 28% of patients were well-controlled by Asthma Control Test/Asthma Control Test-Caregiver Report and 18% by Asthma Impairment and Risk Questionnaire. Forty-four percent of participants reported not following their prescribed medical plan. Four key themes emerged from the focus groups: (1) asthma symptom control and monitoring are often inadequate; (2) treatments are often used incorrectly; (3) communication between health care professionals and patients or caregivers is often ineffective; and (4) concerns related to treatment and desires to improve treatment.Conclusion: Control of asthma symptoms is suboptimal in the vast majority of patients and both patients and caregivers do not feel sufficiently informed about asthma. Health care providers should be encouraged to engage patients and caregivers in shared decision making for managing asthma and selecting treatments that integrate patient values, preferences, and lifestyles.Keywords: chronic obstructive pulmonary disease, qualitative, inhaler, maintenance therapy, rescue therapy, corticosteroid, asthma management, asthma control, shared decision-making, Asthma Control Test, ACT, Asthma Impairment and Risk Questionnaire, AIRQ, Adult Asthma Adherence Questionnaire, AAAQ, Treatment Satisfaction Questionnaire for Medication, TSQM
