Suboptimal Control of Asthma Among Diverse Patients: A US Mixed Methods Focus Group Study

Abstract

Purpose

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

Abbreviations

AAAQ, Adult Asthma Adherence Questionnaire; ACT, Asthma Control Test; ACT-CR, Asthma Control Test-Caregiver Report; AIRQ, Asthma Impairment and Risk Questionnaire; COPD, chronic obstructive pulmonary disease; GINA, Global Initiative for Asthma; ICS, inhaled corticosteroids; NAEPP, National Asthma Education and Prevention Program; OCS, oral corticosteroids; PRO, patient-reported outcome; SABA, short-acting beta-agonist; TSQM-9; Treatment Satisfaction Questionnaire for Medication.

Data Sharing Statement

Due to the nature of this research, participants of this study did not agree for their data to be shared publicly, therefore, the data is not available.

Ethics Approval and Informed Consent

The study was approved by the Advarra Institutional Review Board (protocol reference no. Pro00039195). Prior to the focus groups, all participants completed an online consent form. This study complied with the Declaration of Helsinki.

Acknowledgments

The authors thank Phil Leventhal, PhD, Holly Richendrfer, PhD, and Stephen Gilliver, PhD of Evidera for providing medical writing support, which was funded by AstraZeneca in accordance with Good Publication Practice (GPP3) guidelines (http://www.ismpp.org/gpp3).

Author Contributions

M. George, Z. Balantac, C. Gillette, N. Farooqui, T. Tervonen, C. Thomas, I. Gilbert, H. Gandhi, and E. Israel contributed to the conception and design of the study. Z. Balantac, T. Tervonen, and C. Thomas contributed to the acquisition of the data. M. George, Z. Balantac, C. Gillette, N. Farooqui, T. Tervonen, C. Thomas, I. Gilbert, H. Gandhi, and E. Israel contributed to the analysis and interpretation of the data, drafted or revised the article; agreed on the journal to which the article was submitted; gave final approval of the version to be published, and agree to be accountable for all aspects of the work and to ensure that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Disclosure

Maureen George works as a consultant for AstraZeneca, Genentech, Sanofi Genzyme/Regeneron, Teva. She also serves as a speaker for AstraZeneca. Zaneta Balantac, Tommi Tervonen, and Caitlin Thomas are employees of Evidera, which was paid by AstraZeneca for work related to this study. Chris Gillette works as a consultant for AstraZeneca. Nabeel Farooqui is part of a speaker bureau for AstraZeneca, GlaxoSmithKline, Teva, Regeneron, and Genentech. Ileen Gilbert and Hitesh Gandhi are employees and shareholders of AstraZeneca. Elliot Israel reports personal fees from AB Science, Amgen, Biometry, Cowen, Equillium, Glaxo, Merck, NIH, PCORI, Allergy and Asthma Network, Genentech, NHLBI, Westchester Medical Center, Yale School of Medicine, Pneuma Respiratory, PPS Health, Regeneron, Sanofi Genzyme, grants and personal fees from AstraZeneca, Avillion, Novartis, personal fees and non-financial support from TEVA, grants from Gossamer Bio, non-financial support from Circassia, NAEPP: National Asthma Education Prevention Program, Journal of Allergy and Clinical Immunology, royalties from UpToDate, and stock option from Vorso Corp, outside the submitted work.

Additional information

Funding

This study was funded by AstraZeneca.