Asia-Pacific Survey of Physicians on Asthma and Allergic Rhinitis (ASPAIR): physician beliefs and practices about diagnosis, assessment, and treatment of coexistent disease

Figures & data

Table 1 Demographic characteristics of physicians by country

	Total N=1,204	China N=200 (A)	India N=200 (B)	Malaysia N=202 (C)	Philippines N=200 (D)	Thailand N=200 (E)	Vietnam N=202 (F)
Age (years) <35 (n=327) 35–44 (n=372) 45–54 (n=309) 55–64 (n=153) >65 (n=35)	27 31 26 13 3 NT	11 43 CF*** E**D* 35 CF*** E* 10 1 NT	10 34 F* 33 CF*** 18 C*** AF* 7 NT	47 ABD*** E** 25 16 5 3 NT	15 33 F* 27 C**F* 19 C*** F**A* 6 NT	31 ABD*** 29 26 CF** 16 C** F* – NT	50 ABDE*** 22 17 9 1 NT
Gender Male (n=566) Female (n=638)	47 53	34 66 B*** CF**	76 ACDEF*** 25	48 AD** 52 B***	32 69 BF*** C**E*	43 D* 57 B***	50 D*** A* 50 B***
Type of practice Government clinic/ office (n=155) Government hospital (n=598) Private clinic/office (n=234) Private hospital (n=217)	13 50 19 18	0 98 BCDEF*** 0 3	6 A*** 29 D* 32 AEF*** 34 ACEF***	9 A*** 35 D*** 43 AEF*** B^a 13 A*	14 A*** B** 19 35 AEF*** 33 ACEF***	11 A*** 70 BCDF*** 5 A** 16 A***	38 ABCDE*** 49 BD*** C** 3 A* 11 A**
Years in clinical practice Mean Median	15.5 14	19.4 CEF*** D** 20 (SD 7.8)	19.7 CEF*** D** 18 (SD 10.4)	12.0 9 (SD 9.4)	16.1 CF*** E* 15 (SD 10.7)	14.0 CF* 13 (SD 9.1)	11.9 9 (10.2)
Continuing medical education Asthma management and treatment (n=1,000) AR management and treatment (n=818)	83 68	89 BE** 72 C***	77 70 C***	85 E* 53	89 BE** 85 CEF*** AB**	76 66 C*	84 63 C*

Notes: Values shown as % unless stated otherwise.

* P<0.05,

** P<0.01,

*** P<0.001 (95% confidence level).

Abbreviation: NT, not tested due to small sample size; SD, standard deviation.

Figure 1 (A) Physician beliefs about the existence of coexistent asthma-AR. (B) Physician beliefs about the importance of treating coexistent asthma-AR.

Notes: Total (n=1,204), China (n=200), India (n=200), Malaysia (n=202), Philippines (n=200), Thailand (n=200), Vietnam (n=202). Percentages for specific responses <1%, not shown.
Abbreviation: AR, allergic rhinitis.

Figure 2 Impact of coexistent asthma-AR on (A) sleep and (B) daily activities.

Note: Total (n=1,204), China (n=200), India (n=200), Malaysia (n=202), Philippines (n=200), Thailand (n=200), Vietnam (n=202).
Abbreviation: AR, allergic rhinitis.

Figure 3 Relative impact of asthma, AR, and coexistent asthma-AR on healthcare resource use: (A) frequent unplanned clinic or emergency room visits and (B) hospitalizations for an uncontrolled disease.

Note: Total (n=1,204), China (n=200), India (n=200), Malaysia (n=202), Philippines (n=200), Thailand (n=200), Vietnam (n=202). Percentages for specific responses <1%, not shown.
Abbreviations: AR, allergic rhinitis; ER, emergency room.

Figure 4 Management of coexistent asthma-AR.

Notes: Total (n=1,204), China (n=200), India (n=200), Malaysia (n=202), Philippines (n=200), Thailand (n=200), Vietnam (n=202). Percentages for specific responses <1%, not shown.
Abbreviations: AR, allergic rhinitis; ENT, ear-nose-throat specialist.

Table 2 Preferred treatment for coexistent asthma-AR

	Total N=1,204	China N=200	India N=200	Malaysia N=202	Philippines N=200	Thailand N=200	Vietnam N=202	P-valuea
Combination of inhaled corticosteroids and intranasal corticosteroids (P<0.001)	47	71	40	52	38	59	26	<0.001
Combination of oral LTRA and inhaled corticosteroids (P<0.001)	22	6	20	16	34	19	36	<0.001
Only inhaled corticosteroids (P<0.001)	4	1	10	1	3	1	9	<0.001
Only intranasal corticosteroids (P<0.01)	2	3	5	0	1	1	2	<0.01
Oral corticosteroids and oral antihistamines (P<0.01)	6	8	10	3	7	2	4	<0.01
Inhaled corticosteroids and oral antihistamines (P<0.001)	15	5	11	23	17	16	17	<0.001
Only oral/inhaled antihistamines (P<0.001)	1	5	3	0	0	0	0	<0.001
Only LTRA (NS, P>0.05)	1	1	3	2	1	0	1	NS
Other responses combined (NS, P>0.05)	2	2	1	2	1	4	0	NS

Notes:

a Kruskal-Wallis Test. Values shown as %. Q. From the following pharmacological treatments, what is your preferred treatment for a patient with coexistent asthma-allergic rhinitis? 1) Combination of inhaled corticosteroids and intranasal corticosteroids. 2) Combination of oral anti-leukotrienes and inhaled corticosteroids. 3) Only inhaled corticosteroids. 4) Only intranasal corticosteroids. 5) Oral corticosteroids and oral antihistamines. 6) Inhaled corticosteroids and oral antihistamines. 7) Only oral/inhaled antihistamines. 8) Only LTRA. Physicians may also have answered ‘Other’ and been asked to specify, ‘Do not know’ or refused to answer’.

Abbreviations: AR, allergic rhinitis; NS, not significant (P>0.05); LTRA, leukotriene receptor antagonist.

Figure 5 Physician beliefs about patients’ treatment preferences.

Note: Total (n=1,204), China (n=200), India (n=200), Malaysia (n=202), Philippines (n=200), Thailand (n=200), Vietnam (n=202).

Table 3 Factors influencing treatment choice

	Total N=1,204	China N=200	India N=200	Malaysia N=202	Philippines N=200	Thailand N=200	Vietnam N=202
Practice guidelines	62	50	82	69	17	86	53
Physicians’ personal experience	49	63	85	49	8	56	22
Availability (in stock)	30	29	18	49	15	45	19
Treatment on the drug list or clinic/insurance formulary	19	31	13	27	0	20	20
Patient preference	25	34	16	34	10	36	13
Patient affordability	50	55	33	42	70	51	54
Other responses combined	0	0	0	0	0	0	2

Notes: Q. What factors, excluding individual patient characteristics, influence your choice of treatment? (response options not read or shown to respondents). Values shown as %.

Table S1 Criteria to assess AR symptoms among asthma patients and asthma symptoms among AR patients

	Total	China	India	Malaysia	Philippines	Thailand	Vietnam
	(N=1,204)	(N=200)	(N=200)	(N=202)	(N=200)	(N=200)	(N=202)
Criteria to assess AR symptoms among asthma patientsa
History of nasal symptoms	88	100	95	74	78	97	79
History of eye symptoms	50	61	75	45	8	78	17
Family history of AR/atopy	47	59	66	33	28	71	16
Symptoms due to seasonal allergens	46	79	61	23	6	58	33
Symptoms due to recurring allergens	33	41	50	24	0	59	10
Exposure to environmental hazards/pollutants	30	38	37	24	24	28	26
Skin prick or IgE testing	14	17	25	6	1	26	3
Withdraw AR treatment/start trial AR treatment	7	9	6	3	0	24	0
Other responses combined	7	0	0	12	0	4	24
Criteria to diagnose asthma symptoms in AR patientsa
Clinical history of wheezing/SOB/chest tightness/cough	91	100	94	87	78	100	82
Family history of asthma/atopy	56	79	85	31	34	72	28
Exposure to common asthma triggers	43	74	57	32	14	63	9
Lung function tests confirmation	34	57	40	17	5	50	26
Reversibility/methacholine challenge	25	35	32	12	2	50	12
Withdraw respiratory treatment/start trial respiratory treatment	4	1	6	1	1	16	0
Guidelines (eg, GINA, ARIA)	2	0	0	12	0	0	0
Exacerbations	1	0	0	0	0	1	4
Clinical examination	2	0	0	0	0	1	13
Other responses combined	5	0	0	2	0	3	22

Notes:

a Responses to these questions were not elicited from a predetermined list. Values shown as %

Abbreviations: AR, allergic rhinitis; ARIA, Allergic Rhinitis and its Impact on Asthma; IgE, immunoglobulin E; GINA, Global Initiative for Asthma; SOB, shortness of breath.

Table S2 Most common criteria used to assess asthma control in asthma patients with AR (open-ended question)

	Total (N=1,204)	China (N=200)	India (N=200)	Malaysia (N=202)	Philippines (N=200)	Thailand (N=200)	Vietnam (N=202)
Type and frequency of symptoms	84	92	85	77	72	92	76
Frequency of nighttime awakenings	36	55	63	16	7	52	4
Interference with normal activities apart from work	30	29	49	14	0	65	6
Interference with work or household work	21	28	38	7	0	41	1
Interference with exercise	20	43	28	8	5	26	1
Lung function with spirometry (FEV1) or peak flow	18	32	45	12	4	3	4
Number of exacerbations	29	30	40	5	5	66	13
Validated patient-reported outcomes via questionnaires	8	20	16	5	5	2	1
Use of reliever bronchodilators for symptom control	11	11	24	12	1	9	5
Medication use and frequency, excluding SABAs	20	25	33	15	0	21	12
Medical history, including number of office visits	30	44	31	11	8	50	22
Patient or family feedback	16	43	0	9	0	30	2
Examination or clinical evaluation	31	38	45	12	4	55	15
Other responses combined	7	1	0	0	0	1	40

Note: Values shown as %.

Abbreviations: AR, allergic rhinitis; FEV1, forced expiratory volume in 1 sec; SABA, short-acting beta-agonist.

Table S3 Most common criteria used to assess asthma control in asthma patients (open-ended question)

	Total	China	India	Malaysia	Philippines	Thailand	Vietnam
	(N=1,204)	(N=200)	(N=200)	(N=202)	(N=200)	(N=200)	(N=202)
Type and frequency of symptoms	84	91	92	73	63	87	84
Frequency of nighttime awakenings	49	74	62	27	8	77	23
Interference with normal activities apart from work	34	38	49	13	0	72	10
Interference with work or household work	27	37	36	10	1	55	4
Interference with exercise	33	57	32	22	8	58	5
Lung function with spirometry (FEV1) or peak flow	32	58	47	11	11	42	11
Number of exacerbations	38	45	40	8	10	89	17
Validated patient-reported outcomes via questionnaires	18	28	25	19	3	24	2
Use of reliever bronchodilators for symptom control	30	22	30	24	5	73	9
Medication use and frequency, excluding SABAs	32	34	37	17	3	59	23
Medical history, including number of office visits	35	45	34	18	1	54	36
Patient or family feedback	21	41	41	8	0	22	3
Exam or clinical evaluation	30	44	36	5	3	52	22
Other responses combined	5	0	3	0	0	3	23

Note: Values shown as %.

Abbreviations: AR, allergic rhinitis; FEV1, forced expiratory volume in 1 sec; SABA, short-acting beta-agonist.