Key Point

A communication gap exists between physicians and asthma patients regarding asthma education, treatment compliance, and side effects.

Findings from the Global Asthma Physician and Patient (GAPP) Survey revealed a communication gap between physicians and asthma patients that contributes to adverse treatment outcomes.¹ "The discrepancy highlights the lack of optimal patient-physician communication and patient understanding about asthma and treatment side effects," reported Michael A. Kaliner, MD, and colleagues at the annual meeting of the American Thoracic Society.

The survey, conducted by Harris Interactive on behalf of the GAPP Survey global advisory board, includes data on patients and physicians from 16 countries—Australia, South Africa, Japan, Belgium, France, Germany, Ireland, Italy, the Netherlands, Poland, Spain, Switzerland, the United Kingdom, Brazil, Canada, and the United States. To be included in the study, patients had to be 18 or older with a diagnosis of asthma, while physicians had to have been practicing medicine for three to 30 years. Inclusion criteria also required physicians to see more than three adult patients and to write more than one prescription for asthma medications per week. Each country surveyed about 100 individuals in each of the two groups, with the exception of the US, which surveyed 208 patients and 224 physicians. In total, 3,459 physician and adult patient surveys were conducted worldwide between May 18 and August 24, 2005.

A MAJOR COMMUNICATION ''GAP''

According to Dr. Kaliner and his colleagues, 54% of patients are unaware that even mild asthma can be fatal. Fifty-three percent said they discussed an asthma treatment plan with their physician, whereas 87% of physicians reported discussing this with patients. Patients reported that 16% of the time spent at office visits was devoted to asthma management discussions, whereas physicians stated that 28% of the time spent at office visits was devoted to this topic.

The investigators also found that perceptions of adherence to therapy varied widely between physicians and patients. Thirty-five percent of patients reported taking their medication according to their physician’s instructions, while physicians reported that none of their patients take medication as instructed.

The findings revealed that many patients are unaware of side effects associated with inhaled corticosteroid therapy. Nineteen percent, 39%, and 46% of patients, respectively, were unaware of short-term side effects, long-term side effects, and decreased production of cortisol. In contrast, physicians perceived awareness of these respective topics to be only 3%, 7%, and 23%. "In many cases, patients are not able to identify these side effects," said Dr. Kaliner, Medical Director of the Institute for Asthma and Allergy in Chevy Chase, Maryland. Dr Kaliner is also President of the World Allergy Organization and a Professor at George Washington University School of Medicine in Washington, DC.

The researchers also noted that when patients recognize side effects, treatment compliance is affected. Of patients who have experienced at least one side effect, 24% switched medications, and 26% considered skipping doses, they said.

"I think part of the problem is the limited time the health care provider has with the patient," said Michael S. Blaiss, MD, a Clinic Professor in the Division of Allergy/Immunology at the University of Tennessee Health Science Center in Memphis. "The key to treating chronic conditions such as asthma is to enhance patient treatment compliance through better patient education, increase communication among physicians and patients, and improve treatment conditions," he said.

According to the findings, treatment compliance improves with increased patient education. "Health care providers need to learn to be good listeners and allow the patient to address all concerns. I believe patients should write down all questions and bring [them] to their visit," said Dr. Blaiss. He noted that on many occasions, patients fail or forget to discuss important issues. "Use of physician extenders to educate patients with chronic diseases like asthma would be beneficial."

—Karen L. Spittler

Reference
1. Kaliner M, Dahl R, Blaiss M, et al. Global Asthma Physician and Patient (GAPP) Survey: patient-physician communications and barriers to treatment—US adult findings. Presented at: annual meeting of the American Thoracic Society; May 22, 2006; San Diego, Calif.

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