Many physicians prioritize managing asthma symptoms over exacerbations: Survey

In a recent survey, many physician respondents rated asthma symptom control as a higher priority over reducing exacerbations as their primary treatment goal, according to results published in Respiratory Medicine.

“Across all four countries included in our survey, physicians ranked symptom severity over exacerbation risk as the most important factor when prescribing daily maintenance medication,” R. Chapman, MSc, MD, FRCPC, FACP, FERS, clinician investigator at Toronto General Hospital Research Institute and the University of Toronto, and colleagues wrote. “In addition, most physicians prioritized preventing symptoms over reducing the risk of exacerbations as their main treatment goal for both patients with mild (GINA Steps 1-2) and moderate (GINA Steps 3-4) asthma (except in Canada where exacerbation risk was ranked higher for patients with moderate asthma). However, for patients with severe asthma (GINA Step 5), more physicians in Australia, Canada and the Philippines ranked exacerbation reduction over symptom control as their primary treatment goal.”

Patients and physicians, respectively, from Australia (n = 305 and n = 200), Canada (n = 308 and n = 202), China (n = 300 and n = 201) and the Philippines (n = 303 and n = 200) completed an online survey from July to August 2020. Patients were aged at least 18 years with a current or past physician asthma diagnosis. Physicians were in primary care treating four or more patients with asthma per month and had at least 3 years in clinical practice.

Of the 1,216 patients who responded, 8% to 15% reported using maintenance and reliever treatment, with 66% to 81% using regular maintenance therapy with or without an as-needed reliever medication. A higher proportion of patients reported being aware of maintenance and reliever treatments in China (51.7%) and the Philippines (37.3%) compared with patients in Australia and Canada (20% for both). In comparison, more than 70% of physicians in Australia, Canada and China reported awareness of maintenance and reliever treatment.

Nine percent to 29% of patients and 24% to 45% of physicians were unaware of maintenance and reliever treatments. Eighty percent to 95% of physicians who prescribed maintenance and reliever treatment reported prescribing an additional non-inhaled corticosteroid as-needed reliever medication.

Despite high awareness of medications cited by the respondents, most physicians reported prescribing SABAs in addition to a maintenance and reliever treatment regimen.

Across all countries, 48.2% to 62.9% of patients were classified as having mild asthma and 28.4% to 36.3% were classified as having moderate asthma by their physicians.

Most surveyed physicians reported rating their patients’ asthma symptom control over their asthma exacerbation reduction as the main treatment goal for patients with mild (29.3%-45.1% vs. 9.3%-15.4%) and patients with moderate asthma (24.2%-43.6% vs. 20.9%-30.2%). In addition, surveyed patients reported their asthma symptom relief as very important.

Most patients (71.5% to 77.5%) reported taking their medication as often as they take their quick-relief inhaler if their physician prescribed a new inhaler with a steroid and quick-relief medication, according to the researchers.

“Despite the recommendation for treatment with as-needed inhaled corticosteroid/formoterol to achieve symptom control for patients across the asthma severity spectrum, there appears to be a limited implementation and understanding of maintenance and reliever treatment,” the researchers wrote. “There is therefore a need for improved education on treatment strategies, particularly treatment regimens involving as-needed inhaled corticosteroid/formoterol.”