Barriers to asthma treatment in the United States: results from the global asthma physician and patient survey

Abstract

Background: : The Global Asthma Physician and Patient (GAPP) survey evaluated the perceptions of both physicians and patients on the management of asthma. Here we present the results from the United States (US) subpopulation of the GAPP survey.

Methods: : The GAPP Survey was a large, global study (physicians, n = 1733; patients, n = 1726; interviews, n = 3459). In the US, 208 adults (aged ≥18 years) with asthma and 224 physicians were recruited. Respondents were questioned using self-administered online interviews with close-ended questionnaires.

Results: : Physician and patient responses were found to differ in regard to perception of time spent on asthma education, awareness of disease symptoms and their severity, asthma medication side effects, and adherence to treatment and the consequence of nonadherence. Comparison of the US findings with the global GAPP survey results suggest the US physician-patient partnership compared reasonably well with the other countries in the survey. Both patients and physicians cited a need for new asthma medication.

Conclusions: : Similar to the global GAPP survey, the US-specific findings indicate that in general there is a lack of asthma control, poor adherence to therapy, and room for improvement in patient-physician communication and partnership in treating asthma.

Figure 1

Asthma medications currently being prescribed by physicians as first-line therapy for differing severities of asthma. Physician question: Which medication or medications* do you prescribe as first-line treatment for: 1) mild intermittent asthma; 2) mild persistent asthma; 3) moderate persistent asthma; and 4) severe persistent asthma? *Physicians could provide more than one medication as a first-line treatment for each severity of asthma.

Figure 2

Reasons for patients switching asthma medications. Question: Since being diagnosed with asthma, have you ever switched from one asthma medication to another or discontinued an asthma medication because....?

Figure 3

Average physicians satisfaction with currently available asthma treatments. Question: On a scale of 1-10 where "1" means "extremely dissatisfied" and "10" means "extremely satisfied" how satisfied are you with these currently available types of medications for treating asthma overall?

Figure 4

Proportion of office visit devoted to asthma education. Patient Question: During a typical visit with your doctor or health care professional, what percentage of the time do you or did you spend discussing how to improve techniques for successful management of your asthma? Physician Question: During a typical patient visit, what percent of time do you or other health professionals in your office spend on patient education regarding asthma?

Figure 5

(A) Frequency of discussions about short- and long-term side effects of asthma medications. Physician questions: When you prescribe asthma medications to your patients, how often do you discuss local side effects such as oral thrush, pharyngitis or hoarseness? When you prescribe asthma medications to your patients, how often do you discuss the potential for systemic side effects such as osteoporosis, cataracts or glaucoma? Patient questions: How often do you or did you discuss short-term side effects of your asthma medication related to your mouth or throat--such as fungal infection, sore throat or hoarseness--with your doctor or health care professional? How often do you or did you discuss long-term side effects of your asthma medication--such as weight gain, weakening of the bones or changing bone density, cataracts or glaucoma--with your doctor or other health care professional? (B) Frequency of physicians informing patients of being prescribed an ICS. When you prescribe inhaled corticosteroids alone or in combination, on average, what percent of the time do you tell your patients that they will be taking a steroid?