Table 3 Summary of key review findings

Patient perceptions

Understanding of disease

In general, patients (or caregiver) lack knowledge of their asthma and its causes

Only 22% thought asthma therapy reduced inflammation [11]

Patients are aware of asthma symptoms, but are often willing to tolerate poor control or are unaware of the risks

92% of patients experienced limitations of activities due to asthma, and 48% had difficulty with sleeping [6]

Despite poor control, many patients still describe themselves as 'well controlled'

>65% had symptoms during the last week, although >80% considered themselves to be 'under control' [25]

Symptom control

Inappropriate use of available drugs may contribute to poor control

21.3% and 26.4% of patients with 'some' and 'severe' control limitations, respectively, actually used anti-inflammatory drugs [27]

More aggressive anti-inflammatory treatment can improve control

Addition of a secondary anti-inflammatory agent (LTRA) improved sleep (87% of patients), early waking (80%), daily functionality (85%), and need for rescue medication (77%) [6]

Patients often do not realize asthma drugs have side effects

61% of parents of children with asthma did not realize inhaled corticosteroids had side effects [16]

Patient satisfaction

Patient satisfaction with their treatment is low

In general, these figures are understatements and inference gives higher possibilities

Patient satisfaction (and participation) with their management is often low

28% of patients did not tell their physician in consultation about troublesome coughing, and 36% failed to mention difficulty in sleeping [15]

Admitted compliance with treatment is often poor, expressed both by lack of as well as excessive use of prescribed treatment

45% of patients admitted using their medication excessively [19]

Compliance

Patients cited steroid use as a major reasons for lack of compliance

One-third of patients expressed dissatisfaction with long-term steroid treatment [26]

Lifestyle issues for patients and family

Control

Lack of control was mentioned as being associated with reduced QoL in a number of surveys

General comment

Disease severity

Correlation between QoL and disease severity was suggested

General comment

True impact

The impact of asthma on QoL is often understated

General comment

Lifestyle restrictions

Patients reported substantial lifestyle restrictions

Irrespective of disease severity, approximately 70% report substantial lifestyle restrictions [26]

Families

The QoL of families of children with asthma is also clearly affected

20% of parents stated that their work attendance was affected, and 50% said their own lives were affected [14]

Child specific

Management

Generally children are better managed than adults despite some parental reservations about disease

Asthmatic children are significantly greater consumers of resources than asthmatic adults, despite having better initial asthma control [32]

Perceptions

As in adult asthmatics, there is a marked difference between perception and reality of symptom control in children (or by their caregivers)

65% of children with asthma or their carers considered their asthma to be well controlled, although 37% had difficulty breathing, 34% had nocturnal waking, 29% had dry cough, and the ability to talk was affected in 29% at least once weekly [17]

Therapy understanding

Parental understanding of their child's medication (and compliance) can also be poor

33% of parents of asthmatic children did not understand the role of 'controller' versus 'preventer' therapies, and only 38% of parents took their controller medication on a regular basis [12]

Treatment needs

There seems to be a particular demand for better treatments for children

70% of parents of asthmatic children were concerned about the effects of inhaled corticosteroids [11]

Healthcare providers

Etiology

Some HCPs do not fully understand some of the recent advances in the understanding of asthma etiology

59% of physicians questioned considered allergy the main cause of asthma, with only 35% (and only 16% of pediatricians) citing the underlying inflammation. In the same survey, however, 92% of physicians understood that leukotrienes were important mediators of inflammation in asthma [11]

Treatment needs

Some of the surveys examined physicians' inconsistent use of anti-inflammatory agents in asthma among the suboptimal numbers of patients actually being treated

92% of physicians considered anti-inflammatory drugs 'essential' in asthma care, although only 20% of patients were receiving these agents [27]

Diagnosis

There was practical support for the need for improved diagnosis of asthma leading to improved management

The utility of decision-making tools and self-reporting questionnaires for assessing disease severity and optimizing therapy can measure and improve treatment compliance [31]

Similarities and differences between HCPs and patients

Similarities

In most relevant studies, patients and HCPs generally agreed that better treatments with fewer side effects would be desirable

General comment

Substantial differences

HCPs and patients disagreed over symptom control

Only 1% of patients considered themselves symptom free, compared with 24% of their general practitioners [21]

HCPs and patients disagreed over compliance levels

HCPs believed that 'all' of their patients complied with treatment, whereas only 60% of patients actually did according to HCP definition [20]

HCPs and patients disagreed over concern towards side-effects

General comment