Patient attitudes and beliefs influence asthma control

Published online: November 19, 2017

Asthma is a complex disease that has many different clinical phenotypes. Over the years, refinement and recognition of these phenotypes has helped to drive the development of targeted asthma therapies. However, experience in clinical practice suggests that patient attitudes may also play an important role in disease management. Characterizing the different attitudinal and personality traits of patients with asthma may contribute to the development of tailored interventions to improve overall disease management.

Two large multinational studies were conducted to examine patient attitudes and behaviors regarding asthma and its management. The REcognise Asthma and LInk to Symptoms and Experience (REALISE) surveys were conducted in Europe and Asia in 8000 and 2467 patients, respectively, aged 18–50 years and who used social media. The REALISE surveys revealed that many patients with asthma did not consider themselves to be “sick”, and many ignored their asthma to “feel normal and fit in.” In a study published in The Journal of Allergy and Clinical Immunology: In Practice, Professor Thys van der Molen and colleagues further explored patient responses from the REALISE Europe survey, with the aim of identifying distinct clusters of patients who shared common beliefs and attitudes towards asthma and its management.

The REALISE Europe survey respondents could be categorized in five distinct clusters, based on their attitudes and behavior regarding eight aspects of asthma and its management. These clusters identified patients who were:
•    “Confident and self-managing” (10.4% uncontrolled)
•    “Confident and accepting of their asthma” (30.5% uncontrolled)
•    “Confident but dependent on others” (47.5% uncontrolled)
•    “Concerned but confident in their healthcare professional (HCP) (86.2% uncontrolled)
•    “Not confident in themselves or their HCP” (83.5% uncontrolled)

The differences in asthma control between these clusters related to differences in clinical aspects such as patients” use of reliever medication, adherence to treatment and health behavior. These findings could influence existing asthma management guidelines by identifying distinct attitudinal clusters of patients who may benefit from targeted interventions tailored to their unique needs, beliefs and behaviors. For example, almost 90% of patients in the “Confident and self-managing” group had well- or partially-controlled asthma and so may need different attention compared to patients in the “Concerned but confident in their HCP” cluster, who generally had poorly-controlled asthma. The latter group also had high levels of information-seeking behavior and confidence in their HCP. Providing clear and reliable information to these patients and regularly checking their inhaler technique could help them to achieve better asthma control while alleviating their concerns. Similarly, half of the patients in the “Confident but dependent on others” cluster had uncontrolled asthma, but they relied heavily on their HCP, suggesting that more HCP-guided education and empowerment may help to improve asthma control in these patients while reducing reliance on their doctor.

These findings could have a large impact on daily clinical practice. The five distinct attitudinal clusters of patients may need different approaches in order to optimize asthma management. Further research is now needed to determine how patients and HCPs can quickly and accurately identify to which cluster the patient belongs, findings that will also provide a greater understanding of the optimal use of shared decision making in these patients. Exploring which interventions could be beneficial for patients in each of the attitudinal clusters is also important. Finally, patient attitudes and behavior may influence the management of other chronic diseases in clinical practice.

Funding for the REALISE survey was provided by Mundipharma International Limited.

The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.

Close-up of pine tree branches in Winter Close-up of pine tree branches in Winter