Discrepancy between patient-perception and guideline-defined asthma control in Asia: a survey of over 2400 patients

Abstract

BACKGROUND/AIM: A recent survey (REALISE) has revealed that patients in Europe perceive their asthma to be well-controlled despite the presence of symptoms. We report data from a similar survey of patients which assessed if such discrepancy is seen in Asia. METHODS: Online surveys were completed by patients (aged 18–50 years, >2 prescriptions for asthma in the past two years), recruited via validated consumer panels from 8 countries in Asia. RESULTS: A total of 2,467 patients participated, split across the following geographies: Mainland China (30%), Hong Kong (8%), Indonesia (7%), Korea (20%), Malaysia (6%), Philippines (6%), Singapore (8%), and Taiwan (12%). Mean age of respondents is 34 years, and relatively equal proportion of males (54%) and females (46%). While 89% consider their asthma to be well-controlled, only 18% can be classified as such according to GINA guidelines, the rest being partly controlled (32%) and uncontrolled (50%). In the past 7 days before completing the survey, 35% used their reliever inhaler > 3 times, 38% experienced symptoms > 3 days in a week, 64% had symptoms that interfere with normal activities, and 71% had night-time awakening due to asthma symptoms. In the past year, 33% have been hospitalized, 38% of the respondents had emergency visits, and 73% required oral steroids for worsening asthma. Despite symptoms and exacerbations, 82% do not consider their asthma as serious, 80% regard their state of health as similar as or better than other people their age, and 82% describe themselves as confident in managing their asthma. Interestingly, more than 2/3 of the respondents relate ‘control’ to managing attacks rather than absence or minimal symptoms. Patients’ definitions of well-controlled asthma include: attacks are controllable with medical help, reduction of attacks within a time-frame, and prevention of attacks through lifestyle modification or alternative medicines (e.g. traditional Chinese medicines). CONCLUSION: Patients consistently overestimate their own asthma to be controlled rather than what their clinical symptoms suggest. This discrepancy may be due to fundamental difference on how patients define ‘control’ which is currently geared towards management of exacerbation, instead of pre-defined level of symptom control. A shared understanding of such concepts between patients and physicians may help in achieving treatment goals in asthma care.