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Physicians’ underestimation of asthma control: what are the modifiable factors?

Published online: May 14, 2019

Although an accurate review of the control status is essential for adequate asthma management, assessments of asthma control are sometimes different between patients and physicians, and the underestimation has a negative impact on current symptom control and future risk. Physicians’ perception of asthma control has a direct impact on treatment options and patients’ outcomes. However, few studies have provided detailed data regarding the differences between patients and their physicians in the perception of asthma control. Moreover, the modifiable factors that can be useful to attenuate this discordance have not been not fully verified.

In a recent article published in The Journal of Allergy and Clinical Immunology: In Practice, Matsunaga and colleagues investigated the physician-patient discordance in the perception of asthma control and explored whether certain factors could be responsible for this dissociation. This study was conducted in 1,697 patients visiting routine asthma reviews at 29 primary or secondary facilities in Yamaguchi, Japan. Before the review, patients completed the Asthma Control Questionnaire (ACQ) under the supervision of a medical staff. This questionnaire is a simplified composite measure that assesses the current symptom control according to five items. In this study, an ACQ score of 0.75 or more was defined as not well-controlled asthma assessed by patients. Physicians were blinded from the ACQ results and recorded their perception of asthma control. After the review, physicians provided detailed clinical data.

This observational study revealed that the perception of the physicians did not show a good agreement with the patients’ asthma control based on the ACQ scores. The patient-physician discordance rate was 35.4%. Dissociation of perceptions was noticeable especially in patients whose asthma was not well-controlled. Importantly, the discordant physician-patient pairs had a significantly worse ACQ score than the concordant pairs, but no difference in the use of asthma controller medications was observed between the groups. An ACQ score of 0.75 or more and lack of lung function assessment were identified to be independent risk factors of the discordance between physicians and patients in the perception of asthma control.

Over the past decades, it has been recognized that asthma patients tended to underestimate their lack of control. However, the present study indicates that a “double underestimation” by patients and physicians may be involved in inappropriate asthma management and inadequate asthma control. Periodic use of objective parameters such as the ACQ score and lung function testing could have a pivotal role in attenuating the physician-patient discordance in the perceptions of asthma control.

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