Physicians often underestimate asthma control levels
medwireNews: Researchers have found that physicians often underestimate the level of asthma control in patients.
In their observational study of 1697 patients surveyed during routine asthma visits, the rate of discord between the patients’ asthma control based on Asthma Control Questionnaire (ACQ)–5 scores and physicians’ perceptions of asthma control was 35.4%.
The physicians, unaware of their patients’ ACQ scores, perceived that asthma was well-controlled in 79.6% and not well-controlled in 20.4%. In fact, ACQ scores showed that the rates were 52.2% and 47.8%, respectively.
This dissociation was particularly apparent in patients whose asthma was not well-controlled, with physicians underestimating asthma control in more than 65% of 811 patients with an ACQ score of 0.75 or above. By comparison, only 7.7% of 886 patients with well-controlled asthma were perceived by physicians as not controlled.
The level of concordance between physician and patient asthma control was deemed weak based on analysis by the kappa index, with a κ coefficient value of 0.274.
Kazuto Matsunaga (Yamaguchi University, Ube, Japan) and co-researchers observed that the discordant physician–patient pairs had worse ACQ scores than concordant pairs, at an average of 1.3 versus 0.7. The use of inhaled corticosteroids and other controllers received by 95.7% of patients did not differ between the two groups, however.
Multivariate logistic regression analysis confirmed that not having well-controlled asthma and not having lung function testing were both independently associated with the discordance in the perception of asthma control, increasing the risk by a significant 110% (p<0.0001; confidence interval [CI] 1.87–2.37) and 87% (p<0.0001; CI 1.56–2.31), respectively.
The team acknowledges that “it is well known that adherence by physicians to recommend the use of spirometry is not sufficient,” noting that nearly half (43.2%) of the patients they surveyed had not recently been assessed for lung function.
They therefore recommend that “periodic use of objective parameters such as Asthma Control Questionnaire and lung function testing could have a pivotal role in attenuating the physician–patient discordance in the perception of asthma control.”
The researchers comment in The Journal of Allergy and Clinical Immunology: In Practice that the level of discord reported may be slightly overestimated due to the survey excluding patients with an exacerbation in the past 4 weeks, as a potential confounding factor, the presence of which would have alerted physicians to poor asthma control.
But they note that “the long-term goals of asthma management are to achieve good symptom control and to minimize future risk of exacerbations.”
Given that “double underestimation” by patients and physicians may be involved in poor asthma management, the team states the need for there to be focus not only on patients’ underestimation of disease control, but also physicians’.
By Lucy Piper
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