Understanding of Asthma Treatment Strategies from Physicians? and Patients? Perspectives

14 Sep, 21

Introduction

The 2021 Global Initiative for Asthma (GINA) report recommends two treatment tracks based on the choice of reliever. As-needed inhaled corticosteroid (ICS)/formoterol is the recommended initial therapy for patients in Track 1 and use of ICS whenever short-acting ?-agonist (SABA) is taken or daily low-dose ICS for patients in track 2. These recommendations are partly based on the findings of SYGMA studies. The investigators of this study assessed how these as-needed ICS/formoterol regimens were implemented across different socioeconomic and healthcare systems in real-world settings.

Aim

The Asthma Patients' and Physicians’ Perspectives on the Burden and Management of Asthma (APPaRENT) study evaluated the patients’ and physicians’ perspectives on these latest GINA recommendations in Australia, Canada, China and the Philippines.

Method

Study Design

Multinational, cross-sectional online survey.

Treatment Strategy

Primary care physicians (general practice, family medicine, and/or internal medicine physicians) were selected.
In Canada, respirologists and/or respiratory therapists were also included.
The recruited physicians needed to have >3 years in clinical practice and treating >4 asthmatic patients per month on average.
Patients >18 years of age with physicians’ diagnosis of asthma were selected.
Patients and physicians were invited to complete an online survey.

Results

The questionnaire was answered by 1216/70,183 patients and 803/8376 physicians.
Majority of the physicians classified the disease severity of their patients as mild, moderate or severe.
Physicians classified 48–63% of their patients as mild (GINA Steps 1–2) and 28–36% as moderate (GINA Steps 3–4) and 10-16% as severe (GINA Step 5).
Overall, 66 to 81% of the patients were using regular maintenance therapy with or without as-needed reliever therapy, out of which only 8–15% of patients were using maintenance and reliever treatment (MART).
Approximately 9–29% of patients and 24–45% of physicians were unaware of MART, and among those who prescribed MART, an additional (non-ICS) as-needed reliever was prescribed by 80–95%.
The main treatment goal as per the physicians were symptom control as compared to exacerbation reduction.
From the patients’ perspectives, 50-90% considered symptom relief as very important.

Conclusions

Most physicians focused on the prevention of asthma symptoms over exacerbations.
ICS/formoterol was the preferred symptom reliever as per the GINA report.
The survey findings demonstrated a lack of awareness and understanding of MART dosing among physicians.
There is a need for improved education and strategies to implement GINA recommendations effectively in real-world clinical practice.

Respir Med. 2021 Jun; 186:106524. Doi: 10.1016/j.rmed.2021.106524.