APPaRENT 3: Asthma Patients' and Physicians' Perspectives on the Burden and Management of Asthma in Seven Countries

Abstract

Introduction: Asthma management is strongly dependent on physician and patient beliefs and perceptions about the disease and its long-term treatment. The APPaRENT 3 study was conducted to explore factors influencing treatment choice and to understand patients' and physicians' attitudes and perspectives on the use of controller inhalers in regular versus flexible dosing for asthma management.

Methods: This cross-sectional survey of patients with asthma and treating physicians was conducted in seven countries: Indonesia, Malaysia, Philippines, Thailand, Vietnam (patient survey only), Saudi Arabia, and the United Arab Emirates. Assessment was carried out through an online/face-to-face questionnaire, where patients' viewpoints were focused on their attitudes and beliefs about asthma and treatment adherence, whereas physicians' viewpoints were gathered on their attitudes and beliefs about asthma management, knowledge of and adherence to asthma treatment guidelines, and asthma treatment regimens.

Results: Overall, 1400 patients (mean age, 34 years) and 599 physicians (mean age, 43 years) were included in the survey. Physicians similarly prioritised symptom control (39%) and exacerbation reduction (40%) in moderate asthma, whereas patients prioritised symptom control (41%) over exacerbation reduction (22%). Although both groups (physicians, 86%; patients, 84%) perceived asthma as well-controlled, poor management was evident based on Asthma Control Test (ACT) scores (mean, 15.7; standard deviation, 4.14; 82% had an ACT score < 20) and high symptom burden (39% reported nighttime awakenings or early mornings ≥ 2 nights/week). Most patients (76%) with moderate asthma were prescribed regular dosing, with the most common treatment being inhaled corticosteroid (ICS)/long-acting β₂-agonist (LABA) with as-needed inhaled short-acting β₂-agonist (SABA; 20%). Among patients on maintenance and reliever therapy, 93% of patients received a separate inhaled reliever.

Conclusions: Despite high symptom burden, patients overestimated their level of asthma control. Physicians prioritised controlling symptoms and reducing exacerbations as treatment goals for moderate asthma, often prescribing regular dosing with ICS/LABA with as-needed inhaled SABA.

Keywords: Asthma; Asthma control; Asthma exacerbation; Asthma regimen; Guideline adherence; Patient viewpoints; Physician perspectives.

Fig. 1

Forest plot showing the odds ratios of uncontrolled asthma (ACT score < 20) versus controlled asthma (ACT score ≥ 20) for various patient-reported variables. N, 729; events, 602; pseudo-R², 0.2632; 95% CI are shown within parentheses. Since the ACT regression included adherence as a predictor variable, the analysis was restricted to patients receiving controller treatment while those on inhaled reliever only were excluded. Moreover, only patients with mild and moderate asthma were considered in this regression. Since patients with severe asthma in the regression patient base were "uncontrolled" (i.e. ACT < 20), severe asthma became a definitive predictor, leading to the exclusion of deterministic patients from the analysis. Consequently, the regression was conducted without their inclusion. ACT Asthma Control Test, CI confidence interval, MART maintenance and reliever therapy, N total number of physicians included in the analysis, R coefficient of determination, UAE United Arab Emirates

Fig. 2

Physician-reported percentage of patients treated with different treatment classes for moderate asthma: a overall and b across countries. a Mean % values across all countries combined are reported; b mean % values of individual countries are reported. p value (determined by ANOVA means test for continuous data) indicated significant differences between countries. ^ap < 0.0001; ^bp < 0.01; ^cp < 0.05. ANOVA analysis of variance, ICS inhaled corticosteroid, LABA long-acting β₂-agonist, MART maintenance and reliever therapy, N total number of physicians included in the survey, excluding those who responded ‘don’t know’ or ‘prefer not to say’, SABA short-acting β₂-agonist, UAE United Arab Emirates

Fig. 3

Physician-reported preferred controller approach for patients with moderate asthma using regular controller therapy with ICS/LABA: a overall and b across countries. a % proportion values across all countries combined are reported; b % proportion values of individual countries are reported. ICS inhaled corticosteroid, LABA long-acting β₂-agonist, N total number of physicians included in the survey, excluding those who responded ‘don’t know’ or ‘prefer not to say’, SABA short-acting β₂-agonist, UAE United Arab Emirates

Fig. 4

Experiences and perceptions in asthma treatment. N total number of physicians included in the survey, excluding those who responded ‘don’t know’ or ‘prefer not to say’. Note: Patient responses are on a positive scale