More than two thirds of adults with uncontrolled asthma in the United States mistakenly believe that their condition is under control, according to the results of a survey released in May by GlaxoSmithKline. The survey results, researchers say, may suggest uncontrolled patients feel a false sense of confidence in managing their condition that may be driving recurring symptoms, and doctor, emergency room and urgent care visits.
“Understanding patient misperceptions of their degree of asthma control is critical to improving the quality of their asthma care,” says Mark Forshag, M.D., a pulmonologist and U.S. medical affairs lead at GSK. “The survey illustrates there is still a significant need to help patients go beyond merely coping with symptoms to managing their condition.”
The GSK survey found that the misperception of control is pervasive, even when uncontrolled patients are grouped into those who are “not-well controlled” and those with more asthma symptoms, or “very poorly controlled.” The findings show that among “not-well controlled” surveyed asthma patients, 78 percent believe that they actually do have their asthma under control. Among those classified as “very poorly controlled,” 55 percent reported thinking their asthma is under control.
Seventy-six percent of respondents who think their asthma is under control feel confident that they can do the tasks and activities needed to manage their condition in order to reduce their need to see a doctor. However, 64 percent of these patients visited a health care provider as a result of their asthma symptoms, averaging three visits over the past 12 months.
While many uncontrolled asthma patients state they try to proactively manage their condition with medication and trigger avoidance, nearly three in four (74 percent) experience symptoms multiple times a week. Additionally, while 89 percent of uncontrolled asthma patients are confident they are capable of changing certain behaviors to better manage their condition, only one in two (50 percent) of these patients report having a clear understanding of their illness. This false sense of confidence, researchers believe, suggests patients may lack the necessary tools to effectively engage in the management of their disease.
And of course all of this has a measurable impact on the need for care and the patient’s day to day activities. One in five (20 percent) of uncontrolled asthma patients needed to visit an emergency room or urgent care facility due to their condition in the past 12 months. Seventy percent of uncontrolled asthma patients who believe their asthma is under control go on to report that their condition holds them back from doing things they’d like to do – interfering with exercise (85 percent), sleep (78 percent), enjoyment of life (67 percent), and social life (45 percent) in the past 12 months. Fifty-three percent of those who are employed missed work in the past 12 months because of their asthma, with these patients averaging eight missed days of work in the past year. And more than half (56 percent) of uncontrolled asthma patients admit their condition is a source of stress in their life.
According to Dr. Forshag, the GSK survey was inspired by a phenomenon that physicians encounter all too often – patient under-reporting.
“Physicians have become accustomed to seeing patients who report feeling well, but after specific questioning about symptoms and a physical exam, are actually not well controlled,” he told Med Ad News. “Multiple factors can contribute to this disconnect, such as a desire to not see themselves as having a chronic illness or a desire to be seen by their physician as a ‘good patient.’ In some cases, patients may experience their symptoms for such a long time that they begin to see them as ‘normal.’”
This under-reporting undermines the ability of the physician to render optimal care, and for the patient to achieve the best possible outcome. Denial of symptoms may also lead to decreased adherence with medications. And of course in the case of asthma all of this allows chronic airways inflammation to persist unchecked, contributing to frequent debilitating exacerbations, and perhaps to permanent changes to the shape and structure of the airways.
“You’d expect that these patients who had poor or very poor scores on the Asthma Control Test looking back over the last four weeks, would realize they weren’t doing well,” Dr. Forshag says. “You’d believe that they would perceive a need for better self management skills. You’d be wrong. Despite frequent symptoms leading to significant impacts on their daily live activities and worries about their future, most patients felt their asthma was controlled and that they had a good handle on self management.”
So what to do? “Understanding the misperceptions of control and the realities of a patient’s true asthma condition is a critical first step in closing the asthma ‘awareness gap,’” Dr. Forshag told Med Ad News. “If a patient is able to truly realize the impact that their asthma has on their day-to-day life – from sleep to social activities to exercise – they can engage in an open and frank discussion with their healthcare provider about how they can better manage their condition.”
One step towards that realization is making sure that patients are aware of the tools that are available to improve their outcomes. “For asthma and many other conditions, ‘disease management tools’ include strategies to avoid triggers, alleviate symptoms, stay on-track with a treatment plan or lifestyle change, to self-assess whether symptoms are getting better or worse, and to measure their progress against specific goals,” Dr. Forshag says. “Understanding these tools – and learning that they are available in the first place – is tied directly to patient-physician dialogue and education. As doctors, we need to make sure that we share the necessary information and strategies with our patients so that it’s easier to learn about, track and manage their asthma.”